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1 Week 5 Assignment: Assessment of Addiction and Co-occurring Disorders Morgan Jarrell MFT5108: Impact of Addiction and Addictive Behavior on Family Systems Dr. Gerald Thauberger 02/09/2024

ADDICTION AND CO-OCCURING DISORDERS 2 Diagnostic Assessment Tools for Substance Abuse and Mental Health Issues Substance use is a prevalent health burden, often concurrently occurring with mental health issues, increasing risks of compromising patients' health. Substance use encompasses the inappropriate use of prescribed or recreational drugs, which often leads to abuse due to over- dependence on medicines to transcend reality or numb pain. It is worth noting that mental issues resulting from issues including but not limited to losing loved ones and tragic life experiences may exacerbate substance use, leading to substance use disorder (abuse) (Farris et al., 2021). In the case involving Ji-Woo, the continuous use of opioids may be exacerbated by her mental health issues that result from the tragic accident she endured and her urge to numb the pain of losing a close friend. Opioids are synthetic prescribed medications that help relieve pain by obstructing neurotransmitters of pain between an individual brain and the body (Morgen, 2017). Besides, they often help in numbing pain signals by inducing a high and happy feeling, which is the reason for causing addiction and dependence among its users. In this regard, understanding the intersectionality of individual urges and the need to escape reality may provide crucial insights into how substance abuse concurrently occurs with mental health disorders. Based on the case study, it is undoubtedly true that the continuous dependence on opioids is due to her mental health issues arising from the need to forget the tragic experiences of the accident last summer and the loss of a friend. This paper follows an in- depth review of the literature and the case study to discuss pertinent culturally sensitive diagnostic assessment tools to assess Ji Woo's reliance on opioids and her mental health following her clinical manifestations, such as self-harm and losing interest in things she enjoyed before the accident. The paper will further discuss a differential diagnosis for the mental health issue co-curring with the patient's mental issues, and the pivotal role family systems play in substance use disorder, including its benefits and disadvantages.

ADDICTION AND CO-OCCURING DISORDERS 3 Assessment Assessment tools must affirm an individual's cultural relevance and significance. Culture plays a significant role in deciding individual diagnosis and treatment plan decisions. Ji Woo has a Korean accent and holds high regard for cultural influence in care plans, such as collective decision-making involving the family in making a clinical diagnosis. Assessment Tool For Substance Use Based on the patient's condition, the most appropriate diagnostic assessment for her substance use disorder is the addiction severity index (ASI). ASI is a medically proven assessment tool that integrates questions to assess an individual's drug reliance by addressing their seven main domains of behaviors and the environment, such as an individual health status, drug use, familial status, mental health status, and support (Ljungvall et al., 2019). ASI is culturally sensitive and considers all these aspects of an individual by paying attention to their cultural beliefs or attitudes regarding substance use and accepted behaviors about the use of substances. From the case study, Ji Woo is of Korean accent whose culture may accept pain- relieving medications to help in quick recovery. However, despite the culture condoning pain medications, Ji Woo shows reliance and dependence on continuously using opioids to numb memories of the accident, help her sleep, and forget her friend's loss by seeking unregulated ways of obtaining these drugs. Ji Woo's undeniable efforts to get and use medications portray a typical pattern of addiction, which may require an addiction severity index to assess her severity of opioid addiction. ASI is administered clinically by healthcare professionals or self-reporting and assesses the seven aspects of an individual using questions and rating them on a scale of 0 to 9 (Reiter et al., 2019). Scores between 0 and 1 indicate no problem, 2 to 3 indicate a slight problem, 4 to 5 indicate a moderate problem requiring attention, and 6 to 7 and 8 to 9 show severe problems warranting an intervention.

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ADDICTION AND CO-OCCURING DISORDERS 4 Assessment of Mental Health Issues According to Ji Woo's mental health condition, the most preferred assessment tool is the patient health questionnaire (PHQ-9). As the name suggests, the diagnostic tool has nine relevant questions. It is a reliable and feasible study, considering it has been approved and validated in different healthcare and cultural settings. An individual or a patient exhibiting relevant symptoms, such as avoiding things or activities they once enjoyed or lacking the ideal strength to fight the feelings of losing a job or a loved one, must self-reflect and answer these questions. The assessment tool rates these symptoms based on their occurrence, such as likely to manifest or probability of unlikeness. It provides insights into how often an individual endures such feelings or symptoms. Based on Ji Woo's mental health condition and opioid use disorder, PHQ-9 is undoubtedly the best diagnostic assessment tool to determine if the condition has escalated and may require integral treatments. However, it is worth noting that some assessment tools may be inappropriate for assessing Ji Woo's substance use disorder co-occurring with mental health issues. For instance, the Opioid Risk Tool (ORT) may be inappropriate as it is brief and only provides a narrow self- report on the risks of opioid abuse. ORT only assesses risks for abuse, which may be inappropriate given Ji Woo's addiction status to the medications. In general, the choice of the assessment tool should be systemic and consider the input of the family system based on the collective decision-making model that governs the administration of the patient's treatment plans. Applicability of Assessments to Diverse Populations Individuals' health needs are diverse and influenced by many factors, including culture, language, religious beliefs, and familial structure. Before incorporating a particular diagnostic assessment or treatment modality, it is worth considering all these aspects and integrating a clinical intervention that aligns with the patient's culture or preferences. The patient health

ADDICTION AND CO-OCCURING DISORDERS 5 questionnaire meets an ideal and cultural-validated tool among the most diverse populations. According to Kim et al. (2023), PHQ-9 is applied in most diverse healthcare environments across the Korean population and the world due to its high reliability in producing results that have high sensitivity and negative predictive value. This means they use simple language and can be converted to different languages to make it easier for patients to self-report their depressive symptoms, leading to the production of accurate results about the severity of the patient's mental health status. Similarly, the addiction severity index is the most apparent diagnostic tool used in evaluating the severity of substance use disorder across the globe. ASI fits the narrative as the most utilized diagnostic assessment tool to assess an individual's addiction, given its ability to be agile and translate to user-friendly languages and suit family's preferences, making their interpretation and analysis easier. Differential Diagnosis From the case study, it is evident that Ji Woo portrays symptoms that may indicate a mental health issue. Ji Woo's differential diagnosis is consistent with DSM-V-TR criteria A for major depressive disorder (MDD). According to this criteria, a patient must exhibit four or five symptoms over the past fourteen days, such as self-harm thoughts, feelings of worthlessness, sleep disturbances, loss of things one used to enjoy, and hopelessness (Faris et al., 2023). Studies postulate that individuals with MDD are thrice more likely to abuse drugs, leading to substance abuse disorder. Ji Woo portrays these symptoms, which may be the reason for using opioids to numb the pain induced by the loss of her friend and help her sleep while forgetting the traumatic experience she endured. Systemic Approach Substance use, such as opioid misuse disorder co-occurring with mental health issues, can have an adverse effect on family relationships and functioning. Opioids are highly addictive and

ADDICTION AND CO-OCCURING DISORDERS 6 expensive drugs, and their misuse may induce family conflicts regarding finances due to the high need to maintain the habit (Robinson et al., 2019). Besides, the cost of treatment may be relatively high, which can lead to financial constraints and conflicts within the family. A systemic approach to dealing with these issues involves integrating the family system to provide support and reduce the risks of the progression of such problems. The main advantage of a familial systemic approach is improved family connection, less financial burden, and collective decision-making in the appropriate treatment modality (Esteban et al., 2022). However, disclosing addiction to families is not an easy task. Integrating family may come with doubts and resentment due to familial shame and stigmatization, which can further ruin the established relationships. Provisional DSM Diagnosis From the case study, the principal DSM-5 diagnosis is major depressive disorder (MDD). The primary etiology is due to post-traumatic stress disorder. Ji Woo relieves the moments of the accident, which makes her experience depressive disorders. Due to trauma, she postulates signs of MDD (severe), including losing interest in visiting her grandparents, feeling hopeless, desire to inflict harm, and sleep disturbances (Faris et al., 2021). She was prescribed opioids, but due to her depressive disorders, she decided to numb her pain and thoughts by abusing the drug, leading to a diagnosis of opioid use disorder, which is severe due to her reliance on the drug. However, her commitment to seeing a therapist and family support during her therapies portray a holistic view of getting things done and achieving desired outcomes to promote her mental and overall health. Assessment Summary Substance use disorders such as opioid abuse coupled with mental issues is a severe issue affecting most people worldwide. The paper provides a case study involving Ji Woo, who is

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ADDICTION AND CO-OCCURING DISORDERS 7 enduring opioid use disorder due to a major depressive disorder caused by an accident and the loss of a friend. Providing the proper care requires the integration of assessment tools such as the addiction severity index (ASI) and patient health questionnaire-9 (PHQ-9) to determine the patient's severity of addiction and depressive symptoms and find the appropriate treatment. It is imperative to ensure that the diagnostic tools align with the patient's cultural beliefs and preferences to ensure the promotion of culturally sensitive care. ASI and PPHQ-9 apply to diverse populations, making them suitable assessment tools for such cases. Understanding the client's perspectives, such as their cultural beliefs and attitudes, provides providers with pertinent insights on the appropriate treatment plans. Besides, the integration of treatment family systems and support is ideal for handling addiction problems and mental health issues.

ADDICTION AND CO-OCCURING DISORDERS 8 References Esteban, J., Relinque, C. S., & Alcaráz-Iborra, M. (2022). Effects of family therapy for substance abuse: A systematic review of recent research. Family Process , 62 (1), 49–73. https://doi.org/10.1111/famp.12841 Faris, L. H., Gabarrell‐Pascuet, A., Félez-Nóbrega, M., Cristóbal-Narváez, P., Mortier, P., Vilagut, G., Olaya, B., Alonso, J., Haro, J. M., López-Carrilero, R., & Domènech‐Abella, J. (2021). The Association Between Substance Use Disorder and Depression During the COVID-19 Lockdown in Spain and the Moderating Role of Social Support: a Cross- Sectional Study. International Journal of Mental Health and Addiction , 21 (2), 1157– 1167. https://doi.org/10.1007/s11469-021-00651-7 Kim, M., Jung, S. H., Park, J. E., Sohn, J. H., Seong, S. J., Kim, B., Chang, S. M., Hong, J. P., Hahm, B., & Yeom, C. (2023). Validation of the Patient Health Questionnaire–9 and Patient Health Questionnaire–2 in the general Korean population. Psychiatry Investigation , 20 (9), 853–860. https://doi.org/10.30773/pi.2023.0100 Ljungvall, H., Persson, A., Åsenlöf, P., Heilig, M., & Ekselius, L. (2019). Reliability of the Addiction Severity Index self-report form (ASI-SR): a self-administered questionnaire based on the Addiction Severity Index composite score domains. Nordic Journal of Psychiatry , 74 (1), 9–15. https://doi.org/10.1080/08039488.2019.1666300 Morgen, K. (2017). Substance use disorders and addictions . SAGE Publications . Reiter, M. D. (2019). Substance abuse and the family: Assessment and Treatment (2 nd ed) . Routledge. Robinson, A., Christensen, A., & Bacon, S. (2019). From the CDC: The Prevention for States program: Preventing opioid overdose through evidence-based intervention and

ADDICTION AND CO-OCCURING DISORDERS 9 innovation. Journal of Safety Research , 68 , 231–237. https://doi.org/10.1016/j.jsr.2018.10.011 Sun, Y., Fu, Z., Bo, Q., Mao, Z., Ma, X., & Wang, C. (2020). The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry , 20 (1). https://doi.org/10.1186/s12888-020-02885-6

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