Assessment and Diagnosis
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Apr 3, 2024
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Assessment and Diagnosis
Stephanie A. Flores
College of Humanities and Social Sciences, Grand Canyon University
CNL 501: Substance Use Disorders and Addictions
Dr. Larena Davis
July 5th, 2023
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Assessment and Diagnosis
Introduction
The purpose of this essay is to explain screening, diagnosis, and treatment planning to show a clear understanding of the process as a counseling student. This essay will also discuss how to choose appropriate assessment tools and important considerations that need to be made when doing so, and discuss limitations and benefits to using certain assessment tools. Additionally, understanding the DSM-V criteria for diagnosis is an important part of proper diagnosis and will also be discussed in detail. Another part of the diagnosis and treatment process that needs to be understood is the risks and problems associated with relying solely on the DSM-V for treatment planning. Screening, Assessment, and Treatment Planning Definitions and Descriptions
The National Institutes of Health (2013) defines screening as a brief formal process of identifying potential problems in the client’s life. The use of screening scales can be used to confirm a suspected problem, and lead to further assessment using the information found during screening. Counselors who are leading group sessions may also screen potential group members to ensure they are the right fit for the group and assess if a client will benefit from a group setting
and/or if the members/client may be at risk or put others at risk by being a part of the group. Assessments are used for the purpose of determining severity, diagnosis, and treatment approaches or options (NIH, 2013). Assessments can also be used to determine if there are co-
occurring disorders present in a client that will affect the treatment options. For example, if a substance abuse counselor is meeting with a client they suspect may have an alcohol use disorder, they can use the CAGE (cut, annoyed, guilty, and eye) screening test and based on the answers given, the counselor can then decide if further in-depth assessments need to be
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scheduled in order to determine the severity of their alcohol use and diagnose the client. (Cooper,
2018) With regards to treatment planning, this is the portion of the counseling process where the counselor and client work together to determine specific observable and measurable goals, interventions that will be implemented in order to reach those specified goals, and during this process the counselor will predict expected outcomes from the interventions. Counseling Process for Addictive Disorders
If a counselor meets with a client and suspects they may have an addictive disorder, the use of screening tests and in-depth assessments can be used in order to identify and diagnose the suspected disorder. When first working with a client who may have an addictive disorder, several
factors must be taken into consideration to ensure accurate diagnosis and effective treatment are given to the client. Carr, et al., (2020) highlights the importance of understanding that many substance use related or other addictive disorders (SRAD) often co-occur with one another. This is especially important when taking into consideration that treatment for one addictive disorder may not address all specific addictive disorders the client may be struggling with, or moreover, the reduction or elimination of one addictive disorder may also increase the behavior surrounding a co-occurring addictive disorder. Understanding the risks associated with treating addictive disorders will allow for preventative measures to be put in place and treatment options to address both disorders. Current studies have shown that treatments specifically targeting one or more SRAD increases effective reduction of both treatment targets. (Carr, et al., 2020) Using assessments to identify the possibility of these comorbidities can guide treatment planning. Assessments such as the Composite Measure of Problem Behaviors, or the Risky, Impulsive, and
Self-Destructive Behaviors Questionnaire can identify specific addictive behaviors and the severity of these behaviors alongside the DSM-V for accurate diagnosis of a specific disorder.
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Considerations for Assessment Tools
As mentioned previously, comorbidity must be taken into consideration when selecting assessment tools for diagnosis and treatment planning. The DSM-V (2013) includes sections within each listed disorder regarding comorbidity of mental disorders that can co-occur or mimic
the symptoms of the listed disorder. For example, alcohol use disorder is closely linked to personality disorders such as bipolar disorder and antisocial personality disorder. In addition to that, Lal & Singh, (2018) point out that biological and psychosocial influence the initiation and progression of dependence, and give examples such as age, gender, cultural affiliation, personality, developmental influences, and quality of life as factors for considerations for substance use and addiction diagnosis. It’s also important to note that some assessments measure
certain aspects of a substance use disorder but symptoms that could be present as a result of a pre-existing condition may be inaccurately represented as a symptom attributed to the addictive disorder. All of these potential risks and considerations must be understood in order to avoid undue risk and harm to the client. It is also important to consider what the chosen or potential assessments are measuring and how it pertains to the individual. Some assessments may need to be supplemented with other assessments to fully measure and diagnose all possibly presenting problems surrounding addictive disorders and behavior. Furthermore, consideration for the clients capability and education should be taken into consideration when deciding the mode of administering the assessment. For example, some alcohol dependent individuals may find more comfort in self-administered assessments and provide more honest answers as opposed to a face to face interview, and elderly individuals may need assistance if the assessment is administered on a form of technology or prefer an assessment on paper or in person. (Pautrat, et al., 2022)
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Overview of the DSM-V
The Diagnostic and Statistical Manual of Mental Disorders lists 11 criterion of substance use disorders and discusses the requirements to meet the criterion for a diagnosis under the substance use disorders. These are broken down into four categories for the purpose of organization and these are:impaired control, social impairment, risky use, and pharmacological criteria. For the purpose of this essay, I will give an example of criterion found under each of the four categories. An example of Criterion for substance use disorder under the category of Impaired control is Criterion 1 where the individual may take large amounts of the substance over a longer period of time than was originally intended. Under the social impairment category, Criterion 5 discusses how continued use of the substance affects an individual's ability to fulfill responsibilities and obligations such as work or home duties. Under the risky use category, Criterion 8 mentions an individual’s use of the substance in physically hazardous situations. Lastly, within the category of pharmacological criteria, Criterion 10 discussed varying tolerance among individuals and the increase of tolerance to a substance with prolonged use. The DSM-V (2013) notes that it is based on a pathological pattern of behaviors and that these behaviors are specifically related to the use of the substance. Additionally, when substance use disorders are diagnosed, the severity is indicated by specific ICD-10 coding from mild to severe depending on the number of present symptoms. It is important for providers to be specific and detailed when diagnosing a client. Furthermore, careful consideration must also be made toward co-occurring disorders, tolerance, and withdrawal because of the fact that some symptoms of substance use disorder can mimic symptoms for other reasons (i.e. pre-existing mental disorders or withdrawal symptoms from medical intervention) and not be associated with presenting symptoms related to substance use.
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Risks Associated with DSM-V
While the DSM-V is a vital tool for providers to use as a guide for understanding criteria,
risks, and other important factors associated with diagnoses and specific disorders, it does not contain specific treatment information for the disorders discussed apart from mentioning the need to be knowledgeable of how medicine will affect a client with co-occurring disorders and conditions. The primary use of the DSM-V is for diagnosis rather than treatment. A counselor relying solely on the DSM-V criteria for treatment planning risks overlooking very important additional factors that go into treatment planning as mentioned above and would not provide a good basis for treatment options specific to each client. Benefits and Limitations of Other Assessment Tools
One common assessment tool used for substance use disorders is the Semi-structured Assessment for Drug Dependence Alcoholism (SSADDA). This assessment is used by health care professionals specifically for its link to studies surrounding opioid and cocaine usage and other co-occurring disorders and includes helpful information surrounding the onset and recency of usage, coverage of disorders specifically linked to drug dependency such as gambling, and environmental considerations to drug and alcohol dependency (Pierucci-Lagha, 2005). The SSADDA assessment is beneficial for use by providers because of it’s broad and detailed coverage of specific disorders, the risk to using this assessment is that without the proper prior training and education, the reliability of the assessment varies. The assessment is intended to be administered by a trained lay interviewer. A newer form of assessment tool is the Ecological Momentary Assessment (EMA). The purpose of using EMA’s is to collect data on an individual's behavior in their natural environment (Cleveland, et al., 2023) The convenience of this form of assessment is that the counselor can set specific alerts on an individual's smartphone
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app to indicate the user should respond to a given prompt and that data is sent directly to the evaluator/counselor. The information recorded typically surrounds an individual's daily activities, alongside physical and social activities. The convenience being that the clients will have stronger recall to behaviors and reactions in the moment, rather than days to weeks after the
moment has passed in a formal assessment setting. The drawback of this form of assessment is that users who are not comfortable using technology-based assessments or are not tech-savvy may not want to use this form of assessment.
Conclusion
In conclusion, practicing counselors should be able to accurately depict their clear understanding of processes, risks, and considerations surrounding screening, assessment, diagnosis and treatment planning. Additionally, it is important to understand benefits and risks associated with specific assessment tools and how to appropriately choose them after careful consideration of any risks or factors that need to be addressed when going through the treatment process.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Carr, M. M., Saules, K. K., Ellis, J. D., Staples, A., Ledgerwood, D. M., & Loverich, T. M. (2020). Development and Validation of the Recognizing Addictive Disorders Scale: A Transdiagnostic Measure of Substance-Related and Other Addictive Disorders. Substance
Use & Misuse, 55(13), 2194–2204.
Cleveland, H. H., Knapp, K. S., Cleveland, M. J., Deneke, E., & Bunce, S. C. (2023). Using ecological momentary assessments of negative affect and craving during residential opioid use disorder treatment to predict patients’ relapse to substance use. Journal of Substance Use and Addiction Treatment, 146. https://doi-org.lopes.idm.oclc.org/10.1016/j.josat.2022.208931
Cooper, S. E. (2018). A primer on college student substance use disorders screening, assessment,
and treatment planning. Journal of College Student Psychotherapy, 32(1), 73–89. https://doi-org.lopes.idm.oclc.org/10.1080/87568225.2017.1343107
Lal, R., & Singh, S. (2018). Assessment tools for screening and clinical evaluation of psychosocial aspects in addictive disorders. Indian Journal of Psychiatry, 60, S444–S450.
https://doi-org.lopes.idm.oclc.org/10.4103/psychiatry.IndianJPsychiatry_12_18
National Institutes of Health. (2013). Addressing the specific behavioral health needs of men: screening and assessment. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK144289/
Pautrat, M., Pierre Lebeau, J., & Laporte, C. (2022). Identifying available addictive disorder screening tests validated in primary care: A systematic review. Addictive Behaviors, 126.
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https://doi-org.lopes.idm.oclc.org/10.1016/j.addbeh.2021.107180
Pierucci-Lagha, A., Gelernter, J., Feinn, R., Cubells, J. F., Pearson, D., Pollastri, A., Farrer, L., &
Kranzler, H. R. (2005). Diagnostic reliability of the Semi-structured Assessment for Drug
Dependence and Alcoholism (SSADDA). Drug and Alcohol Dependence, 80(3), 303–
312. https://doi-org.lopes.idm.oclc.org/10.1016/j.drugalcdep.2005.04.005
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