Assessments and Diagnosis 1
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CNL 501-05
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Dec 6, 2023
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Assessment and Diagnosis
College of Humanities and Social Sciences, Grand Canyon University
CNL-501-O504 Substance Use Disorders and Addiction
Introduction
Drug abuse is a multifaceted condition that necessitates long-term and comprehensive
intervention. Individuals who have had challenges related to substance misuse may encounter
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significant obstacles when attempting to cease their addictive behaviors, mostly owing to the
presence of bodily and/or psychological dependencies. Screening, evaluation, and treatment
planning are interdependent processes that are inherently interconnected and reliant upon one
another. There exist three distinct components inside a process that have the potential to be
executed by several agencies. Efficient dissemination of information and adherence to client
preferences are most observed in systems where pertinent entities establish a structured network,
provide personnel with cross-training opportunities, and implement formal protocols for
information sharing and referral (2007). This paper will explore the assessment, screening, and
treatment planning for a client who is searching for treatment for their addiction.
Assessment, Screening, and Treatment Planning
The primary objective of assessment in addiction counseling is to ascertain the presence
or absence of a dependence or addiction, determine the severity of the dependency, and identify
any concurrent co morbid conditions. Subsequently, it is imperative for a counselor to engage in
collaborative efforts towards the development of a personalized therapy approach. The process of
screening and assessment is an essential initial phase in the treatment of addictions. A lack of
reporting of alcohol and substance abuse contributes to the frequent oversight of addiction as a
diagnosis within the domains of psychiatry and counseling (Capuzzi & Stauffer, 2019).
Screening encompasses the utilization of several instruments to identify individuals
within a specific demographic, such as adolescents, who exhibit or are predisposed to a condition
or maladaptive behavior. The process of screening does not lead to the establishment of a
definitive diagnosis (Pilowsky & Wu, 2013). Screening is performed with the intention of
utilizing the outcomes as a foundation for an appropriate care plan. The most effective screening
methods are those that incorporate a minimal number of concise, validated questions capable of
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eliciting precise and dependable responses. In the realm of normal adolescent health care, it is
strongly advised to incorporate a comprehensive biopsychosocial screening, which encompasses
substance use screening as a crucial element (Levy, et al., 2016).
The preparation of the treatment plan, predicated upon the comprehensive data acquired
during the assessment phase, constitutes a pivotal element within the treatment continuum. The
treatment plan has been established through a collaborative effort with the client, with the aim of
addressing therapeutic goals that have been agreed upon by both parties. The significance of the
meticulous and cooperative approach to the development of the treatment plan cannot be
overstated. The treatment plan effectively consolidates, integrates, and assigns priority to the data
gathered during the assessment phase, thereby serving as a comprehensive roadmap for
implementing the prescribed course of action to achieve the specific therapeutic objectives
(Connors, et al., 2013).
Addictive Disorder Assessment Process
A comprehensive evaluation of substance use encompasses a meticulous examination of
the specific kind, quantity, regularity, and repercussions of the individual's substance
consumption, as well as their subjective interpretation of their usage patterns and their
willingness to engage in behavioral modification. In addition, the counselor will do a thorough
examination of the patient's medical and psychological background, as well as evaluate the
presence of any concurrent psychiatric conditions. A genogram will also be completed to find the
familial background and psychological elements that could potentially influence substance abuse
or aid in the process of therapy. A comprehensive physical examination is conducted, and
laboratory tests are requested if deemed necessary. There are several tests that can be conducted
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during the assessment process with the client. However, there are more screening measures
related to alcohol use than there is illicit drug abuse.
Typically, self-administered and interview-based screening methods for alcohol-related
issues evaluate the existence of medical and psychological ramifications associated with alcohol
consumption, as well as symptoms indicative of dependency. Effective screening measures for
alcoholism include the utilization of the Michigan Alcoholism Screening Test (MAST), the
CAGE questionnaire (which stands for Cut down on drinking, Annoyed by criticism of drinking,
Guilty about drinking, and Eye-opener), and the Alcohol Use Disorders Identification Test
(AUDIT). All these assessments need less than 10 minutes to complete, can be scored with no
instruction, and have been implemented in many contexts (Tucker, et al., 2010). There are other
tests that can be completed but there are not as many tests for an individual who is abusing illicit
substances.
Assessment Tool Considerations
The utilization of evaluation tools holds significant importance in the domains of
management and research within the field of addiction psychiatry. When evaluating an
appropriate diagnostic method, it is advisable and encouraged for a counselor to have a
comprehensive understanding of various factors such as the individual's age, familial
background, using patterns, progression, prevalence, cultural influences, gender, and potential
alternative diagnoses related to each substance (Capuzzi & Stauffer, 2019).
According to Piazza (2002), there are five factors that can be used to judge the
appropriateness of an evaluation tool. The five criteria encompassed in this set are sensitivity,
specificity, reliability, validity, and cost-efficiency. The crucial aspect lies in comprehending
whether the evaluation tool effectively elucidates the extent of a client's possible addiction. The
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term "sensitivity" pertains to the frequency with which a tool accurately identifies individuals
with addiction disorders, whereas "specificity" denotes the frequency with which a tool correctly
identifies individuals who do not possess such illnesses. Reliability refers to the degree of
consistency with which a tool accurately identifies the illnesses it is designed to detect. Yet,
validity pertains to the accuracy of the assessment itself. Lastly, cost-efficiency involves an
examination of the expenses associated with administering and scoring the assessment (Capuzzi
& Stauffer, 2019). These evaluation tools offer a neutral environment for a counselor and client
to convene.
Substance Use Disorder Criteria Overview
The DSM-5 does not use the word addiction as a classification. Instead, substance use
disorder is considered a more neutral term that covers a wider range with less focus on
withdrawal. “The text enumerates eleven categories of chemicals, including alcohol, caffeine,
cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other/unknown
substances” (APA, 2022). In general, the diagnosis of a substance use disorder is predicated upon
the identification of a pathological pattern of behaviors that are directly associated with the
consumption and utilization of a particular substance. To facilitate the organizing process, the
diagnostic components comprising criterion A can be categorized into broader groups
encompassing impaired control, social impairment, dangerous usage, and pharmaceutical criteria
(APA, 2022).
Potential Problems of DSM When Diagnosing
The exclusive reliance of counselors on the diagnostic criteria outlined in the DSM-5 for
the purpose of treatment planning may give rise to certain possible issues. Another matter of
concern pertains to the distinction between abuse and dependence. In most of the research
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employing the diagnostic criteria outlined in the DSM-IV, both the criteria for abuse and
dependence have been utilized. The DSM-5 does not maintain this differentiation and instead
utilizes the broader diagnostic of substance use disorder, which may consequently lead to a
potential overlap in estimates of unmet needs (Ritter, et al., 2019). The counselor may not ask the
right questions that can provide insight into the client’s familial history and even with their own
experience. This also gives clients the opportunity to not be honest about their substance use with
the counselor when the counselor is only asking “broad questions.” The DSM-5 provides a
defined set of criteria for diagnosing substance use disorder. However, it is important to
acknowledge that cultural attitudes exert a substantial influence on the diagnostic process.
Two Assessment Examples
If there is a counselor who is working with a client who has an opioid use disorder
(OUD), it would be beneficial for the client to receive medication-assisted treatment (MAT).
(MAT) is widely regarded as a highly recommended best practice for those diagnosed (OUD).
The integration of counseling with pharmacological interventions, including methadone,
buprenorphine, Suboxone, and naltrexone, has consistently demonstrated efficacy in mitigating
cravings and withdrawal symptoms. (MAT) has proven to be beneficial in reducing mortality
rates associated with overdose and substantially enhancing the overall well-being and
functionality of individuals diagnosed with opioid use disorder (Lushin, et al., 2023). In order for
(MAT) to be effective, the client must be a part of the shared-decision making so that they feel
(MAT) is the right choice for them.
A client is coming to seek treatment/assistance for their alcohol dependency, the
counselor should suggest the AUDIT screening instrument. The AUDIT assessment comprises a
primary questionnaire consisting of 10 items and a supplementary clinical procedure consisting
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of 8 items. The AUDIT assessment tool was developed with the purpose of identifying
individuals who engage in hazardous drinking behavior, which elevates their susceptibility to
alcohol-related problems, even if they have not yet experienced any alcohol-associated harm.
Additionally, the tool aims to identify harmful drinkers who have recently encountered physical
or mental harm because of their drinking, but who do not meet the criteria for alcohol
dependence. Lastly, the AUDIT tool also helps in identifying individuals who exhibit alcohol
dependence (Bohn, et al., 1995). It is important that the counselor utilizes not only the DSM-5
for diagnosis of the client but also the assessment tools to get a more accurate depiction of what
the client needs and wants.
Conclusion
A comprehensive grasp of the sequential steps involved in screening, assessment, and
diagnosis, as well as the subsequent development of treatment plans, is crucial for effectively
addressing the needs of those afflicted with a substance use disorder. In addition, utilizing a
motivational communication style, as opposed to a confrontational one, is crucial in enhancing
patient outcomes during the processes of screening, counseling, and treatment. Lastly, it is
important that the counselor understands the multicultural competence of the clients they are
working with. Assessment tools are an important tool to help the client be successful in their
recovery process.
References
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