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Assessment

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an ongoing process through which the counselor collaborates with the client and others to gather and interpret information necessary for planning treatment and evaluating client progress.

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Biopsychosocial perspective

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This recognizes that there are biological, psychological and social causes of substance abuse and dependence.

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Biological factors

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These include brain chemistry problems, which may be genetic, making some people particularly vulnerable to addiction to certain drugs once they try them.

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Psychological factors

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These include cognitive styles, personality traits, and early developmental experiences that may contribute to a client's causes of substance abuse and dependence.

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Social factors

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These include poverty, oppression, poorly developed social skills, and family dysfunction that may contribute to a client's causes of substance abuse and dependence.

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Motivational interviewing

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This is a style of interacting with clents, used not only for assessment, but for all phases of treatment, that is particularly helpful for reducing defensiveness and encouraging therapeutic collaboration between the counselor and client. Uses the interpersonal process to enhance clients' motivation to change, and encourages clients to move on to the next stage of readiness for change.

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Assessment Instruments

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These aid in the identification of, and treatment planning for substance related disorders.

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Reliability

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This refers to the consistency with which an assessment instrument measures.

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Validity

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This refers to what an assessment instrument measures and how it is used.

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Screening Instrument

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This distinguishes individuals who do not have a disorder from those who might have one.

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AUDIT (Alcohol Use Disorders Identification Test)

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The 10 items on this instrument developed by the World Health Organization ask about frequency of drinking, alcohol dependence, and problems caused by alcohol. Scores range from 0 to 40 with a score of 8 or higher indicating the likelihood of harmful alcohol consumption.

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CAGE

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Four questions - yes to one indicates the possibility of alcohol dependence. Cut down? Annoyed by criticism of drinking behavior? Guilty about drinking? Eye-opener?

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DAST

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Drug Abuse Screening Test, adapted from MAST and used to detect abuse or dependence on drugs other than alcohol.

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MAST

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Michigan Alcoholism Screening Test - yes or no to 25 questions.

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RAPS-4 (Rapid Alcohol Problems Screen)

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An answer of yes to one or more questions indcates the possibility of alcohol dependence during the past year. The questions have to do with remorse, amnesia, performance of life duties, and starting the day with alcohol.

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SASSI (Substance Abuse Subtle Screening Inventory)

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This brief self-report is designed to identify individuals with a high probability of having a substance related disorder.

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SASSI-A2

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Substance Abuse Subtle Screening Inventory for Adolescents ages 12 to 18.

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TLFB (Time Line Follow Back Procedure)

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This is a Comprehensive Measure of Drinking which makes connections between significant events in the client's life and alcohol/drug use patterns and intensity, for the past year.

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ADS (Alcohol Dependence Scale)

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This diagnostic instrument is a 25-item instrument that provides a quantitative measure of the severity of alcohol dependence.

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DIS-IV (Diagnostic Interview Schedule - Alcohol Module)

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This diagnostic instrument asks 28 questions that permit diagnosis of alcohol abuse or dependence.

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ICS (Impaired Control Scale)

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This diagnostic instrument is a pencil and paper self-administered insturment that measures clients' attempts to control drinking during the last 6 months and their perception of their ability to control it now.

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OCDS

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Obsessive Compulsive Drinking Scale

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SADD

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Short Alcohol Dependence Data

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SDSS

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Substance Dependence Severity Scale

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ASI (Addiction Severity Index)

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This is a semi-structured interview with seven subscales addressing problems in the areas of family/social status, medical status, employment and support, drug use, alcohol use, legal status, and psychiatric status. It is useful for treatment planning and outcome evaluation with adult clients.

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AUI (Alcohol Use Inventory)

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This self-report inventory is in multiple-choice format, for ages 16 and up. It is based on the multiple condition theory, which takes into account individuals' different styles of drinking, perceptions of alcohol's benefits and consequences, and how they want to deal with drinking problems.

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CBI (Coping Behaviors Index)

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This instrument measures factors related to relapse risk: positive thinking, negative thinking, avoidance/distraction, and seeking social supports.

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WAIS-III (Wechsler Adult Intelligence Scale)

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This is a popular intelligence test.

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The Strong Interest Inventory

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A vocational interest scale that compares clients' interests to those of people who are happy in different occupations.

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MMPI-2

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The Minnesorta Multiphasic Personality Inventory contaings several clinical scales that detect pathology including the MacAndrew Alcoholism Scale.

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The Mental Status Exam

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A series of observations about a client's appearance, behavior, attention, mood, affect, perceptual and thought processes, judgement, and memory at a given point in time. Includes observations of a client's orientation to time, place and person.

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MBTI (The Myers-Briggs Type Indicator)

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This is a personality inventory that looks at clients' preferred ways of being in the world and assigns them to 1 of 16 personality types. Frequently used in vocational and relationship counseling.

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The Beck Depression Inventory II

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Used to track changing levels of depression over the course of treatment for clients age 13 and over. Individuals rate themselves on 21 groups of statements that tap the affective, behavioral, cognitive, and physiological symptoms of depression for the 2 weeks prior to testing.

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Biomarkers

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Measuring these physiological markers at intervals throughout treatment may provide early identification of relapse.

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EMIT

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Enzyme Multiplied Immunoassay Test - this urine testing kit uses antibodies that react to the presence of a drug or its metabolites.

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GGT

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Gamma-glutamyltransferase - indicates prolonged, rather than episodic drinking.

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ASAT

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Aspartate aminotransferase - screens for heavy drinking.

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ALAT

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Alanine aminotransferase - screens for heavy drinking.

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CDT

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Carbohydrate Deficient Transferrin - sensitive enough to pick up moderate drinking over a peoiod of a few weeks.

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SOCRATES

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A readiness-to-change scale that stands for Stages Of Change Readiness And Treatment Eagerness Scale.

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URICA

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A readiness-to-change scale that stands for the University of Rhode Island Change Assessment.

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FTQ

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Family Tree Questionnaire helps clients report information about the incidence of alcohol problems in their blood relatives.

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Genogram

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A pictorial representation of family structure, using a least three generations and a standard set of symbols.

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DSM-IV-TR

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Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (APA, 2000).

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Axis I

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Contains 16 categories of clinical disorders, one of which is Substance Related Disorders.

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Substance Related Disorders

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This category of clinical disorders in Axis I of the DSM IV-TR includes both Substance Use Disorders and Substance Induced Disorders.

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Substance Use Disorders

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This sub-category of Substance Related Disorders includes both Substance Abuse and Substance Dependence.

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Substance Induced Disorders

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These Axis I disorders are a sub-category of Substance Related Disorders and can include Substance Intoxication and Substance Withdrawal, Substance induced delirium, persisting dementia, persisting amnesic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction disorder, and sleep disorder.

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Axis II

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This axis of the DSM IV- TR includes the personality disorders as well as mental retardation.

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Cluster A

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Axis II disorders that feature odd, eccentric, isolative, or suspicious behavior. They include Paranoid, Schizoid, and Schizotypal personality disorders.

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Cluster B

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Axis II disorders that often co-occur with substance abuse and dependence, and are characterized by dramatic, emotional, erratic, or impulsive behavior, or a reduced capacity for empathy. They include Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder and Narcissistic Personality Disorder.

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Antisocial Personality Disorder

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This personality disorder features a pervasive pattern of disregard for and violation of the rights of others.

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Borderline Personality Disorder

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This personality disorder features a pervasive pattern of instability in interpersonal relationships, self-image, affect, and control over inpulses. Features may include frantic attempts to avoid real or imagined abandonment, impulsivity in at least two areas that are self-damaging, chronic feelings of emptiness.

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Histrionic Personality Disorder

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This personality disorder features a pervasive pattern of excessive emotionality and attention seeking, often with provocative dress.

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Narcissistic Personality Disorder

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This personality disorder features a pervasive pattern of grandiosity, need for admiration, and lack of empathy.

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Cluster C

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These Axis II personality disorders feature anxious, fearful, and perfectionistic behavior. They are the Avoidant, Dependent, and Obsessive-Compulsive personality disorders.

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Axis IV

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This axis of the DSM IV - TR contains nine psychosocial and environmental problems that may affect the client's diagnosis, treatment and prognosis, including primary support group, social environment, educational, occupational, housing , economic, healthcare access, legal system/criminal, and other.

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Axis V

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This axis of the DSM IV -TR is the Global Assessment of Functioning (GAF) scale, which assigns a number from 1 to 100 to the counselor's judgement of the client's overall level of psychological, social and occupational functioning.

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Substance Abuse

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A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by at least one of the four following criteria occurring within a 12- month period: recurrent substance use resulting in a failure to fulfill major obligations at home, school or work, recurrent substance use in situations in which it is physically hazardous, recurrent substance use legal problems, and continued substance use despite having persistent or recurring problems caused or exacerbated by the effects of the substance.

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Substance Dependence

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A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 or more of the following 7 criteria: tolerance, withdrawal, increased dose or dosing for longer periods of time, attempts to cut down unsuccessfully, time spent obtaining, using, recovering from use, important social, occupational and recreational activities given up or reduced because of use, physical or psychological problems caused or exacerbated by continued use.

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Physiological Dependence

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Indicated by whether tolerance and withdrawal are present.

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Tolerance

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Defined by either a need for markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of the substance.

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Withdrawal

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Defined by either the characteristic withdrawal syndrome for the substance or the same or a closely related substance being taken to relieve or avoid withdrawal symptoms.

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Specifiers

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Used for Substance Dependence Diagnosis, these six categories are: Early full remission, early partial remission, sustained full remission, sustained partial remission, on agonist therapy, in a controlled environment.

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Polysubstance Dependence

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The proper diagnosis for a client who has repeatedly taken at least three groups of substances, and who meets creiteria for dependence for the substances as a group, but not for the substances individually.

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Dually-Diagnosed

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This client has one or more other psychiatric disorders along with substance abuse or substance dependence. Also known as co-occurring disorders. All disorders should be treated concurrently and aggressively.

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Affect

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The external expression of an internal emotional state.

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Mood

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A sustained emotion. Changes less frequently than affect.

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Delusions

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False beliefs that are maintained despite proof against their truth.

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Hallucinations

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Perceiving something in the absence of a sensory input. May be auditory, visual, olfactory, gustatory or tactile.

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Illusions

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Misperceptions of actual sensory input.

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Problem Statement

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Component of a Treatment Plan that should be stated in client's words whenever possible. Answers the question, "Why are you here?" Include statement of problem and evidence for it.

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Goal Statement

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Component of a Treatment Plan that should be acceptable to the client and answers the question, "What is necessary to remedy the problem?" Should be stated positively - eg. "Client will maintain abstinence," rather than, "Client will not drink."

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Objectives

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Component of a Treatment Plan that states specific things the client will do to meet the goal. Stated in behavioral terms, and are observable, realistic, time specific, appropriate to the level of treatment and measurable.

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Strategies

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Component of a Treatment Plan that states what the counselor will do to help meet the client's objectives. Includes the theoretical model to be used, (eg. reality therapy) and the specific techniques to be employed (eg. assertiveness training or refusal skills training). These are sometimes also called "Interventions".

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Axis I, IV and V

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CASACs are responible for these three axes on the Written Assessment Summary. Other axes can be written up as "deferred" or list symptoms eg. deferred, reports frequent headaches.

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