PASA Lesson 2 - Assessment of Substance Use Disorders PDF

**[Lesson II-Assessment]** **[Approaches of assessment]** -The appropriate method for assessing a substance use disorder depends on the specific objectives of the assessment. -Each assessment tool provides a unique perspective on the disorder, which helps. Identify different aspects of the proble...

**[Lesson II-Assessment]** **[Approaches of assessment]** -The appropriate method for assessing a substance use disorder depends on the specific objectives of the assessment. -Each assessment tool provides a unique perspective on the disorder, which helps. Identify different aspects of the problem. -Using a combination of instruments allows for a more comprehensive and accurate evaluation -Aspects to evaluate: - Presence and severity of the disorder - Aspects such as co-occurring disorders and the overall effect on the individual's life **Assessment of drug abuse:** -Conducted in patients who have tested positive in screening or whose responses suggest significant problems that could limit the effectiveness of a brief intervention. -Assessment objectives: - Identify and clarify the type and magnitude of the problem - Provide data for a formal diagnosis - Establish severity of problem - Determine appropriate level of care - Guide treatment planning - Define a baseline patient's condition for future comparisons - Establish good therapeutic relationships with patient - Assess motivation to change, using standardised instruments - Conduct comprehensive and individual assessment of the user's problems -Key areas of assessment: - Substances with which the patient has had contact and developed a problematic relationship with - Acute intoxication and/or withdrawal potential - Biomedical conditions - Emotional/psychiatric conditions - Acceptance or resistance to treatment - Potential for relapse - Recovery/living environment - Previous intervention - Areas affected by consumption (social, work, academic) - A medical evaluation -Assessment process: - Clinical interviews - Personal history - Self-reports - Lab tests - The assessment process is not separate from the intervention or treatment **Reliability and validity** -Validity concerns whether the instrument assesses the condition that it is designed to evaluate accurately. It is more complex that reliability and is assessed through various methods -Reliability Refers to the consistency of the instrument in reaching the same diagnostic conclusions across different users. Measured using the test-retest method, where multiple clinicians independently assess the same user -Although the instruments discussed are generally reliable and valid, their effectiveness may vary depending on specific contexts **Main evaluation techniques** 1.Interview Fundamental part, always the first part of evaluation. Not only include the patient, but also people from their environment to cross-check the info obtained. Interviews should cover all necessary aspects including the patient's condition. Need to establish a good relationship with the patient during this stage. Recommended to gather general info in the first interviews and conduct more in-depth interviews later. - Structured clinical interviews interviewer follows a rigid and predetermined script of questions. Asked in the same manner, without deviations - Semi-structured interviews (Addiction Severity Interview: Europ-ASI; McLellan et al., 1980) Follow a basic script with key questions, but there is flexibility. Interviewer can explore additional tops and can modify wording or order of questions. Most widely used version today is the European version (Europ-ASI), which evaluates 6 areas: general medical condition, employment and financial status, alcohol and drug use, legal problems, family and social relationships, mental health. 2.Tests and self-reports/questionnaires Specific toll designed to measure presence, severity and impact of addictions on a person. Gather data on the individual's behaviour, consumption habits, consequences faced and associated emotional/psychological patterns. -DUDIT questionnaire (Berman et al., 2005) is an 11-item self-administered screening instrument for drug-related problems, which yields scores on a continuous interval scale and can easily be used in different contexts. -CAGE: brief questionnaire to identify alcohol problems. -The Alcohol Use Disorders Identification Test (AUDIT; World Health Organisation et al., 2001). -For the use of nicotine there is a questionnaire called The Fagerstrom Test for Nicotine Dependence (FTND), validated by Becona and Vazquez (1988). -The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) by the WHO, 2011, detecting problems/risky use of various substances. -The Cannabis Abuse Screening Test (CAST) validated in Spanish by Fernandez-Artamendi et al. (2012) and Rial et al (2002), to assess the degree of cannabis abuse. [Questionnaire AUDIT] 1)3 2)3 3)3 4)0 5)1 6)0 7)1 8)1 9)4 10)0 16= high risk 3.Observation Observing addictive behaviours is complex because the substances in question are toxic and many are illegal, creating ethical issues and accompanying a patient in a natural context is complex. What is possible, desirable and necessary is to observe the repertoire of behaviours and skills that the individual possesses, which will be relevant for assessing needs and planning intervention goals. It is often useful to have records and self-reports derived from the user's self-observation of their consumption behaviour. 4.Objective assessment tools These tests serve as a stimulus to maintain abstinence and form the basis for using programmes such as contingency management based on abstinence. Urine analysis is most common to its ease of on-site detection and the use of "multi panel" methods for quick, cost-effective results on substance use. 5.Third-party reports Common for people with substance use disorders to have received treatment in the past or to be currently under the care of professionals from other areas. Obtaining info from other entities is enriching for the evaluation process. Coordination once the treatment has been completed is essential and, in this case, the patients consent to share info becomes necessary. -An assessment instrument is a tool consisting of a series of questions or items designed to collect/break down and understand the complex dynamics of addiction. -Each instrument provides valuable information from different perspectives, whether through qualitative or quantitative data -The combination of tools allows therapists to tailor treatment to the individual characteristics and need of the patient. **[Europ-ASI + case study]** -An adapted version of the American Addiction Severity Index (ASI). -It is a semi-structured interview designed to collect key information about aspects of the client's life that may contribute to substance abuse disorders. -Serves as the initial step in developing a client profile that will be used by clinical and research staff. -It is important to explain clearly the purpose of the interview to the client and ensure confidentiality. -The rating scale is a 5-point scale where patients must rate the severity of their problems and the importance of treatment on a scale from 0 to 4 (0=not at all, 4=extremely likely) -Follow-up interviews should be conducted at least 1 month after the initial interview. If the client or patient does not understand the question, we need to provide clarification. Can reschedule the interview if the patient has difficulty understanding. -Severity ranges: - 0-1 not a real problem, treatment not indicated. - 2-3 mild problem, treatment likely not needed - 4-5 moderate problem, treatment indicated - 6-7 considerate problem, treatment necessary - 8-9 extreme problem, treatment absolutely necessary -Additional considerations: - Incarceration or inpatient treatment adjust assessment period if the client has been either of these - Inaccurate representation disregard questionable data and document any anomalies - Poor understanding Terminate the interview if the client cannot comprehend or focus adequately -Evaluate whether the information provided is distorted by client misinformation or inability to understand. Document any discrepancies or inconsistencies and clarify them during the interview -Subjective items are rated by the patient using a 5-point scale: 0-4 -Two types of scores are provided for each scale 1)Estimated Rating by the Evaluator (ERE), with a score ranging from 0-9 2)Composite Score (CS), derived from the weighted sum of selected items within each scale. Higher scores indicate greater severity. No cutoff points are proposed. **[Functional analysis + case study]** -Behaviour analysis is grounded in the assumption that behaviour is systematic and determined arising from interaction processes that allow for the prediction and influence of individual actions -The function of behaviour, or its adaptive value, is assessed by examining the functional relationship between behaviour and its immediate and long-term effects -Behaviour is understood not as isolated actions but as interactions between the individual and their environment. External conditions are significant and must be identified and managed to facilitate change. -Behavioural processes are categorised into two types: +-----------------------------------+-----------------------------------+ | Respondent or reflexive | A relationship between an | | | organism and its environment | | | where a response is elicited by | | | an environmental stimulus | | | | | | -Automatic: do not require | | | conscious learning | | | | | | -Involuntary: they are | | | physiological r emotional | | | responses that occur | | | automatically | +===================================+===================================+ | Operant | -Actions that affect the | | | environment, producing | | | consequences that modify the | | | future likelihood of similar | | | actions occurring. | | | | | | -Voluntary: require a learning | | | process and decision-making | | | | | | -Controlled by consequence: | | | behaviour is strengthened if | | | followed by a positive | | | consequence (reinforcement) and | | | weakened if followed by a | | | negative consequence (punishment) | +-----------------------------------+-----------------------------------+ **Introduction of functional analysis:** -Three-term contingency behavioural analysis focuses on the relationship between: - The antecedent context - The organism's response - The consequent stimuli that alter the future probability of the behaviour -Substance abuse is a behaviour influenced by biogenetic and psychological factors -Understanding its function allows for prediction and control -To address dependency issues, It is essential to identify an manage the involved variables, using functional analysis as a key tool in clinical assessment and treatment. -It systemically assesses the environmental factors and the context of behaviours, identifying their antecedents and consequences -Mental health professionals use this approach to tailor treatment plans to ensure that individual needs are met. -Objectives of FA: - Identify high-risk behaviours that could lead to relapse - Provide valuable info about triggers and problematic areas - Enable the creation of more effective and personalised treatment - Help individuals learn and develop tools to prevent relapse - Substitute negative behaviours with positive ones -FA in substance abuse: - Identifies circumstances (antecedent stimuli) associated with substance use - Analyses the consequence (reinforcements or punishments) produce by the substance abuse behaviour -Reinforcers and treatment elements: - Psychoactive substances can act as reinforces, increasing the likelihood of use - They can lead to seeking treatment dye to long-term negative effects - Identifying reinforcing and punitive elements is essential for understand the relationship with the substance and factors that sustain its use. -Behavioural modification the 5 W's (when did the addiction start, where did it begin, why did "X" fall into addiction, with whom did they start the addiction with and what happened as a result of the addiction) -It is essential to have a comprehensive understanding of an individual's substance use history. Including social, environmental and familial factors.