Week 5 discussion response to classmates

Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Van Wormer, K., & Davis, D. R. (2018) and/or American Psychiatric Association. (2013). You need to have scholarly support for any claim of fact or recommendation regarding treatment. I have also attached my discussion rubric so you can see how to make full points. Please respond to all 3 of my classmates separately with separate references for each response. You need to have scholarly support for any claim of fact or recommendation like peer-reviewed, professional scholarly journals. If you draw from the internet, I encourage you to use websites from the major mental health professional associations (American Counseling Association, American Psychological Association, etc.) or federal agencies (Substance Abuse and Mental Health Services Administration (SAMSHA), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), etc.). I need this completed by 03/30/19 at 3pm.

Expectation:

Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note that citations are expected for both your main post and your response posts. Note also, that, although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.

Read a your colleagues’ postings. Respond to your colleagues’ postings.

Respond in one or more of the following ways:

· Ask a probing question.

· Share an insight gained from having read your colleague’s posting.

· Offer and support an opinion.

· Validate an idea with your own experience.

· Make a suggestion.

· Expand on your colleague’s posting.

1. Classmate (D. Ras)

Description of Two Assessment Tools 

           There are many screening and assessment tools in the addiction field that can be helpful and effective. These two things are not the same process. Screening points the counselor in the right direction, but the assessment “defines the nature of the problem and assists in developing specific treatment recommendations for addressing the problem” (Van Wormer & Davis, 2018, p.300). One assessment tool known by some as the “stealth assessment” is the Substance Abuse Subtle Screening Inventory (SASSI) (Van Wormer & Davis, 2018). This is is a brief self-report, easily administered psychological screening measure that is available in separate versions for adults and adolescents (Miller, 1990). Some of the True/False statements in this assessment have nothing to do with substance abuse. For example, “I am often resentful” and “I like to obey the law” (Van Wormer & Davis, 2018). These subtle statements help determine whether the person taking the assessment fits the profile of a chemically dependent person in areas such as “defensiveness, willingness to acknowledge problematic behavior, depressed affect, and likelihood of legal problems” (Van Wormer & Davis, 2018, p.302).

Another assessment tool is the Comprehensive Addictions and Psychological Evaluation (CAAPE) which is a practical tool used to assess co-occurring disorders all in one instrument (Van Wormer & Davis, 2018). This assessment is done through an interview process which takes approximately 30-45 minutes (Van Wormer & Davis, 2018).  It provides qualified professionals with a standardized set of questions which elicits information that may be used in “treatment planning and possibly for motivational enhancement” (Hoffman, 2004, p.1). It covers disorders including: alcohol/tobacco/drug use, depression, mania, panic/anxiety, PTSD, obsessive-compulsive disorder, psychosis, and a wide range of personality disorders (Van Wormer & Davis, 2018).

Description of One Strength & One Shortcoming of Each 

           Miller(1990) discussed how most other current substance abuse screening instruments are rationally constructed, meaning lacking in empirical evidence. However, one strength of the SASSI is that the items listed on this assessment were all borrowed from other empirically derived scales such as the Minnesota Multiphasic Personality Inventory (MMPI), the Psychological Screening Inventory (PSI), the Michigan Alcoholism Screening Test (Miller, 1990). A limitation of the SASSI is there is no empirical evidence that supports its claimed unique advantage to assess substance use with its “subtle statements” which are intended to get around someone’s denial or dishonesty (Van Wormer & Davis, 2018).

           Hoffman (2004) found a strength of the CAAPE is that it has practical utility as an assessment tool in substance abuse evaluations with its acronym UNCOPE. The UNCOPE consists of six questions found in existing instruments and assorted research reports (Hoffman, 2004). Although it efficiently screens for co-occurring mental health and personality disorders, evidence of validity is needed to support any greater use in such assessments (Hoffman, 2004). Another limitation is there is not one question on gambling behavior, along with having costs associated with accessing this tool (Van Wormer, 2018).

Description of How These Assessment Tools Might be Used to Support a Provisional Diagnosis of Substance Related or Addictive Disorder 

           The SASSI with its use of “subtle statements” can be used to support a provisional diagnosis of substance related or addictive disorder. The DSM 5 suggests that individuals with lower levels of self-control, which reflects impairments of brain inhibitory mechanisms, may be predisposed to develop substance use disorders (SUD) (APA, 2013). This fact suggests that SUDs can be seen in some people’s behaviors long before the onset of actual SUD itself (APA,2013). Therefore, the SASSI’s use of subtle statements targets identifying some of these behaviors which could be helpful for an individual who is still in the pre-contemplative stage of change, where they don’t recognize they have a problem.  The CAAPE might be used to support a provisional diagnosis of substance related or addictive disorder through its use of the acronym UNCOPE. These six questions provide a simple and quick means of identifying risk for abuse and dependence for alcohol and other drugs (Hoffman, 2004). The diagnosis of SUD is based on a pathological pattern of behaviors related to use of the substance (APA, 2013). There are four groupings of criterion A which include: impaired control, social impairment, risky use, and pharmacological criteria (APA, 2013). The questions used with the acronym for UNCOPE include:

U: “In the past year, have you ever drunk or used drugs more than you meant to?” Or as revised “Have you spent more time drinking or using than you intended to?”

N: “Have you ever neglected some of your usual responsibilities because of using alcohol or drugs?”  

C: “Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?”

O: “Has anyone objected to your drinking or drug use?”  Or, “Has your family, a friend, or anyone else ever told you they objected to your alcohol or drug use?”

P: “Have you ever found yourself preoccupied with wanting to use alcohol or drugs?”  Or as revised, “Have you found yourself thinking a lot about drinking or using?”

E: “Have you ever used alcohol or drugs to relieve emotional discomfort, such as sadness, anger, or boredom?” (Hoffman, n.d.).

These questions appear to elicit responses covering all areas of criterion A as suggested by the DSM 5.

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Hoffmann, N. G. (n.d.). Retrieved from: http://www.evinceassessment.com/ UNCOPE_for_web.pdf

Hoffmann, N. G. (2004). Comprehensive Addictions and Psychological Evaluation. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mmt&AN=test.3083&site=ehost-live&scope=site

Miller, G. A. (1990). Substance Abuse Subtle Screening Inventory. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mmt&AN=test.215&site=ehost-live&scope=site

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

2. Classmate (L. Sim)

Screening and assessments are important aspects of counseling. The two are not the same, as Van Wormer and Davis (2018) shared screening can assist with moving in the correct way while assessment assists with specific treatment options. There are different assessments available, most presenting with strengths and shortcomings. Further, assessment tools can support a provisional diagnosis of an addictive disorder.

Assessment Tools

           There are different assessment tools available to utilize with those potentially suffering from addiction. Van Wormer and Davis (2018) shared that an important first step is asking open-ended questions to gather an understanding of substance use. One structured assessment to utilize is the Addiction Severity Index (ASI) (Van Wormer & Davis, 2018). The ASI is a commonly utilized tool for addiction treatment, including scales that cover 7 potentially problematic areas (Thylstrup, Bloomfield, & Hesse, 2018). Clients share their experiences over the last 30 days, which scores are called composite scores across the 7 scales (Thylstrup et al., 2018). Also, there are interviewer severity index scores (de Vries, Juhnke, Valadez, & Mărcus, 2015).

           Another assessment tool is the Mental Health Screening Form-III (MHSF-III). Van Wormer and Davis (2018) described this as a screening tool for past or current symptoms of mental disorders. This assessment tool has 18 questions, which is suggested the questions are asked in an interview style, allowing for follow up questions (Van Wormer & Davis, 2018). This assessment tool is utilized because mental illness and substance abuse can worsen the outcomes for each and dual diagnosis is common (Van Wormer & Davis, 2018).

Strengths and Shortcomings

           Both assessments present with strengths and shortcomings. The ASI has 200 items and can take up to 60 minutes to complete (de Vries et al., 2015). This could be a heavy undertaking for a client to complete. Additionally, a client may lose interest and begin to get tired of responding, which could alter the results. This is certainly true if someone is addicted to a substance, as the process may interfere with their use. However, the ASI is comprehensive (DeVries et al., 2015), which is a strength of the assessment. More information can be obtained, initially, supporting the treatment process. When an individual answers all of the items, a clearer picture is created of the true impact of potential substance abuse.

           The MHSF-III is accessible within the public and can be found online (Van Wormer & Davis, 2018), which suggests easier access to the tool. Carroll (2008) shared that the assessment is free and there is no cost with administering or interpreting the results. No cost can encourage individuals to receive assessment who may be undecided. Something as money can skew an individual’s mind. However, the MHSF-III only asks 1 question about each disorder (Van Wormer & Davis, 2018). A misinterpretation or lack of understanding of a question can confuse a client or encourage them to respond in an untrue way. An individual may have experienced something once or for a brief period, but respond yes to a question, suggesting a mental illness. Most people have experienced some form of sadness or anxiety, but it does not mean there is an anxiety or depressive disorder present.

Support of a Provisional Diagnosis

The assessments can support a provisional diagnosis. Research most often supports a connection of dependence severity and psychopathology, which the ASI has a psychiatric question (Thylstrup et al., 2018). This attention to mental illness can assist with understanding the impact of the individual’s substance abuse. Further, the ASI allows for exploration of different aspects in an individual’s life. The purpose of the assessment is to decide the need for treatment in different areas (de Vries et al., 2015). The initial information from the assessment can assist the counselor in understanding the concerns and how they impact the individual’s life. All the information can be conceptualized by the counselor, allowing them to have a provisional diagnosis.

The MHSF-III includes a question about gambling and potential for questions about substance, as it is encouraged to be given in interview format (Van Wormer & Davis, 2018). The inclusion of these questions will assist in understanding a potential provisional diagnosis. Additionally, Carroll (2008) shared that the assessment was designed to be used by those working in the substance abuse field. This supports the idea that substance abuse is a major factor in this assessment. The MHSF-III allows for results that can suggest or deny a provisional diagnosis of an addictive disorder. Further, the mental health aspect can allow a counselor to understand the impact of one’s addiction, which further supports or does not support a diagnosis.

Conclusion

           There are many different assessment and screening tools available for clinicians to utilize with individuals who may be suffering from an addictive disorder. The different assessment tools present with strengths and weaknesses. Potentially, some are more appropriate then others in different situations. Understanding the impact of the assessment results is important as results can support provisional diagnoses.

References

Carroll, J. F. X. (2008). Development of the Mental Health Screening Form III. International Journal of Mental Health & Addiction, 6(1), 72–76. https://doi-org.ezp.waldenulibrary.org/10.1007/s11469-007-9102-8

de Vries, S. R., Juhnke, G. A., Valadez, A. A.. & Mărcus, I. B (2015). Addiction Severity Index (ASI) Findings: Implications for Counseling South Texas Homeless Persons. Journal of Professional Counseling: Practice, Theory & Research, 42(2), 2–16. https://doi-org.ezp.waldenulibrary.org/10.1080/15566382.2015.12033945

Thylstrup, B., Bloomfield, K., & Hesse, M. (2018). Incremental predictive validity of the Addiction Severity Index psychiatric composite score in a consecutive cohort of patients in residential treatment for drug use disorders. Addictive Behaviors, 76, 201–207. https://doi-org.ezp.waldenulibrary.org/10.1016/j.addbeh.2017.08.006

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th
            ed.). Boston, MA: Cengage.

3. Classmate (G. Sim)

AUDIT & The PHQ-9

The AUDIT test (Alcohol Use Disorders Identification Test) was developed by the World Health Organization (WHO) and is the only screening test designed and validated for international use in a variety of populations, cultures and languages. The test is short and flexible and works well in many different contexts: health care clinics, emergency rooms, correctional facilities, outpatient clinics, and other human service agencies. The questions cover 10 items including amount and frequency of drinking, symptoms of dependence, personal problems, and social problems (Van Wormer & Davis, 2018). It is surprising to me that one test can cover this many aspects of alcoholism. The scoring of the test measures levels of risk in order to be used as a prevention tool, as clients become able to assess their own situations with insight, hopefully, into what could happen down the road if they do not make some changes. As a AA sponsor once said, “play the tape all the way to the end.” The AUDIT can be given as a fill-out questionnaire or in an interview setting, and only takes about two minutes to complete. There is also a website that provides scoring and assessment instructions (Van Wormer & Davis, 2018).

PHQ-9

We use the PHQ-9 tool at my company, an outpatient behavioral services agency in an urban setting. The Patient Health Questionnaire is a nine-question screening tool for depression. The simple questions identify factors common in depression and make further exploration, like maybe the Beck Depression Inventory, possible (Van Wormer & Davis, 2018). It is a good tool to identify depression in clients presenting for a different reason also, like for gambling disorder or drug addiction. The test works well in most health care settings and takes just a few minutes for a client to complete. For some settings it might not go far enough, however.

Both tests have sufficient validity and reliability to identify problem behaviors, and in the identification of specific problem behaviors, they lend support to provisional diagnoses from the DSM-5.

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

Required Resources

  • Van      Wormer, K., & Davis, D. R. (2018). Addiction treatment: A      strengths perspective (4th ed.). Boston, MA: Cengage.
    • Chapter       7, “Screening and Assessment” (pp. 295-311)
  • American      Psychiatric Association. (2013). Diagnostic and statistical manual      of mental disorders (5th ed.). Washington, DC: Author.
    • “Substance-Related       and Addictive Disorders” (pp. 481–589)
  • Document: Final      Project (PDF)
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