ch. 2 - Interview, screening and assesment Flashcards
Purpose of Interviewing, Screening, and Assessment:
The initial interview serves as a data-gathering dialogue where the counselor can also begin to craft the narrative regarding the need for treatment and what strengths the client brings to the treatment process
The interview also informs the need for any screening applications. Screening is not just testing, but rather a purposeful and applied clinical measurement to determine the existence of various problems.
Assessment is a more comprehensive application where the pervasiveness or severity of various problems (including substance use disorder) may be further determined.
Need for Strengths-Based Interviewing, Screening, and Assessment Focus:
If not careful, the interview, screening, and assessment procedure can become entirely focused on the negative
Laudet, Morgen, & White (2006) found that social supports, spirituality, religiousness, life meaning, & 12-step affiliation buffer stress effects on enhanced life satisfaction, with the buffer constructs accounting for 22% of the variance in life satisfaction.
Social Support:
Empirical evidence has linked social support to increased health, happiness & longevity.
Social support if a significant concept in the perceived well-being of those with co-occurring substance use and psychiatric disorders.
Low level of support?
shown to be a reliable predictor of relapse
High level of support?
predict a diminished rate of substance use
Spirituality & Religion:
Religious and spiritual beliefs function as protective factors between life stressors and overall perceived quality of life
Growing research supports the notion that religiousness and spirituality may enhance the likelihood of attaining and maintaining recovery from addictions
Recovering persons often report that religion and/or spirituality are critical factors in the recovery process
Possible benefits of religious involvement may include:
Avoidance of drugs
Time -occupying activities incompatible with substance use
Adoption of prosocial values
There is evidence that spirituality may assist recovering individuals avoid future substance use and that among recovering individuals, higher levels of religious faith and spirituality are associate with:
A more optimistic life orientation
Higher stress resilience
More effective coping skills
Helpful components of 12-step affiliate
Sense of social support
Reduced stigma associated with being in a community with others who share similar struggles
12- Step Affiliation
Affiliation with 12-step fellowships, both during and after treatment, is a cost-effective and useful approach to promoting recovery from substance use problems
Evidence suggests that 12-step affiliation benefits extend to psychosocial functioning and enhanced quality of life
Coping Skills:
Critical component of the treatment and recovery process
Provides individuals with strategies to deal with the various life stressors.
Coping strategies include
Cognitive Behavioral Emotional Communication Social strategies
What topics should the interview cover?
Substance use history Psychiatric history Client perspective on spirituality Medical history Family history Social history
Substance Use History:
It’s critical to inquire regarding ALL substances and not just the primary substance
It’s imperative to understand how substances interact with alcohol due to the high prevalence rates of individuals using other substances in conjunction
The following areas should be addressed in regards to substance use history
Age at first use
The frequency & amount of the substance use
As well as the route(s) of administration for each substance, assist the interviewer in gauging the trajectory of substance use increase over time.
Questions regarding consequences of use
Helps pinpoint areas of dysfunction caused by the addiction such as:
Deficits at school
Work
Family
Financial, legal, or medical problems
Examination of any prolonged (30 DAYS OR LONGER) abstinence period
Reasons for the abstinence as well as return to substance use helps the clinician create a timeline
What were the psychosocial constructs that contributed to the abstinence as well as the return.
The Timeline Followback (TLFB) is a clinical tool that helps the clinician see the schedule of substance use and abstinence over a prolonged period of time.
The TLFB can be administered by an interviewer (or client administered)
Ask clients retrospectively to estimate their substance use anywhere between 7 days to 2 years prior to the interview date.
The TLFB serves as a motivational tool to contribute to efforts designed to increase client motivation and readiness for
Psychiatric history
There is a clearly established relationship between substance use and psychiatric disorders
Recent admissions data in the SAMHSA (2015) Treatment Episode Data Set reflected that 33.1% of admitted clients in 2013 came to SUD treatment with a co-occurring psychiatric disorder.
Be mindful that most clients will have a current and/or past experience of an outright diagnosable DSM-5 psychiatric disorder or the presence/history of subsyndromal experiences that, though not rising to a diagnosable level, still cause distress
Clinician must address the following matters in regards to psychiatric history
Is there a history of an independent DSM-5 diagnosed psychiatric disorder?
Regardless of history, is the client demonstrating any current symptoms that may reflect a psychiatric disorder?
What is the history of the client’s psychiatric symptom experiences in conjunction with substance intoxication, withdrawal, or prolonged abstinence?
Are there any instances of distressful emotional experiences that may resemble diagnosable disorders but fail to adhere to any nosology?
Challenges inherent within psychiatric history process
Tremendous overlap betweens substance use and psychiatric symptoms
For example: Experiences of anxiety, depressed mood, or paranoia are symptoms of numerous psychiatric disorders but also occur in various instances of substance intoxication or withdrawal.
Recall that as a clinician you are asking about this complicated and typically unclear relationship with an individual who (due to substance use past and present) is not the best equipped
The deficit in memory may be due to the current memory and other cognitive defects
Due to these issues, the interview may not result in a definitive answer
Client Perspective on Spirituality:
Any good assessment of spiritual support extends beyond a simple census-type yes or no question during the interview process
Spirituality needs to be considered in a twofold manner:
How does the counselor define and think about the concept of spirituality?
The same intrapersonal work counselors do to come up with a spirituality definition and understanding also needs to be applied to all their clients (in essence, a spiritual development parallel process between clients and their counselors.
