Interview, screening and assessment-1.pptx

Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.Counselors work with individuals to identify triggers for relapse and deve

1. Interview, screening and assessment July 2024

2. Explain the diagnostic criteria related to substance use and related disorders.

3. Assessment Assessment is the procedure by which a counsellor identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of a treatment plan. Gather relevant history from client, including, but not limited to, alcohol and other drug abuse, using appropriate interview techniques. Identify methods and procedures for obtaining collateral information from significant secondary sources regarding client’s alcohol and other drug abuse and psychosocial history. Identify appropriate assessment tools. Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding. Develop a diagnostic evaluation of the client’s substance abuse and any coexisting conditions based on the results of all assessments in order to provide an integrated approach to treatment planning based on the client’s strengths, weaknesses, and identified problems and needs.

4. Purpose of interview and screening- ( Activity 3 and Discussion) Discuss how the 3 reasons for conducting an initial interview, screening and assessment can be achieved In SUD interview, screening and assessment, the counsellor needs not only to focus on the negative findings (i.e. lack of self esteem) but needs to be more concerned of the positive findings (Motivation). Describe why you will need to assess for: Social support Spirituality and Religion Stage of change Coping skills

5. assessment The initial assessment occurs at the beginning of the client’s treatment journey and it usually takes place during the initial visit. However, it’s important to note that assessment is an ongoing process that helps in evaluating client progress. During the initial assessment, the counsellor gathers a thorough client history that includes, but is not limited to: Current status of and history related to alcohol and drug use, including any previous treatment Current status of and history related to physical health, including any hospitalizations Current status of and history related to mental health, including any previous treatment Family relationships, including possible issues

6. Employment history and career issues Current legal status and history of involvement with the legal system Emotional and behavioural issues Spiritual beliefs, practices, and concerns of the client Education and basic life skills

7. Strengths the client possesses Access to and use of familial and social support Access to and use of community resources Treatment readiness Level of cognitive and behavioural functioning

8. Note as discussed before Impact of Culture and Gender Spirituality and region Comorbid Mental Disorders Assessment Setting

9. Initial interview serves as a data-gathering dialogue where the counsellor can also begin to craft the narrative regarding the need for treatment and what strengths the client brings to the treatment process. Interview also informs the need for any screening applications Note: Screening is not just testing, but rather a purposeful and applied clinical measurement to determine the existence of various problems In summary: interview, screening and assessment enables c onceptualizing the problem or problems, clarifying the severity of these problems, and informing/motivating the client for the need for treatment. Eventually inform the diagnostic and treatment plan development process

10. Specific Content of the interview Substance use history Type of substance use Understand how substance and alcohol interact with the brain and with different body systems to guide treatment recommendations, as well as further screening or assessment Discuss age at first use- has diagnosis and prognosis implications Frequency and amount of the substance use as well as the route for each substance- assist the client in gauging the trajectory of substance use increase over time

11. Enquire regarding consequences of use- to help in identifying areas of dysfunction caused by the addiction (school, family) Examine any prolonged abstinence as well as the return to use- helps in creating timeline for waxing and waning of substance use common in addiction (psychosocial constructs attributed to abstinence as well as the return) Psychiatric history The relationship between substance us and psychiatric disorders (brain and substances)

12. History if independent DSM 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? Any instances of distressful emotional experiences that may resemble a diagnosable disorder but fail to adhere to a certain classification

13. Client perspective on spirituality note questions should focus on how and why instead yes or no answer(Open ended questions) Core, force or soul- to determine inner strength Meaning to determine purpose to their lives Values of life- determine sense of self-worth Self knowledge NB counsellor should also examine own spirituality (professional journey for genuineness)

14. Medical history Present and past medical, surgical and medications being used Determine if symptoms are related or independent of substance use (see hand out) Family history Reported family history of substance use may indicate genetic predisposition Examine how substance use has entered the family system and the resulting consequences Client’s family of origin Romantic relationship status- dysfunctional Domestic abuse

15. Social history Career history, current employment status- influence of substance use and performance Educational history- dropped out Criminal history Financial health Collateral history- through client’s concern

16. Mental status examination MSE to cover Appearance General appearance Motor status Activity Facial expression Characteristics of speech Blocking Preservation Flight of ideas

17. Emotional state Mood Affect Content of thought Hallucinations Delusions Compulsions Obsessions Ritualistic depersonalization

18. Orientation Person Place Time General confusion Memory Remote past experiences Recall of long ago and recent past experiences

19. Identifying level of harm/severity Social – does it disrupt relationships; Has the individual engaged in violent behavior while drinking? Physical – has the person been injured while under the influence of a substance /medical consequences Economic – is the substance use diverting money needed for other causes Interfering with work Legal problems due to substance Withdrawal symptoms: hand shaking Tolerance: have you increased the amount/strength of substance in order to get the desired effect?

20. Recommended interview content in PHC Referral source Primary presenting problem History of substance use and past treatment Current substance use (frequency, amount, route of administration Current psychiatric symptoms History of current suicidal ideation, intent, plans or acts History of current homicidal ideation, intentions, plans or acts History of non-suicidal self injury ideation, intentions, plans or acts

21. Living arrangements Marital/ relationship status Any children if applicable Family of origin history School and work history Mental status Insight and judgment

22. Screening and assessment Drug testing- for the selection of appropriate treatment

23. Other Tests Alcohol use disorder identification test- concise (AUDIT-C) and CAGE (health practitioners) Drug abuse screen test (DAST-10) Patient health questionnaire (PHQ-2) Single question screening Clinical decision support (CDS) for substance abuse

24. CAGE questionnaire used to identify possible dependence C-Have you ever felt you needed to CUT down on (reduce) your drinking? A – Have people ANNOYED you by criticizing your drinking? G – Have you ever felt GUILTY (or ashamed) about drinking? E – Have you ever felt you needed a drink first thing in the morning (EYE opener) to steady your nerves or to get rid of a hangover?

25. DSM-5 overview for substance related disorders The DSM of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) provides a classification system for the diagnosis of a substance use disorder (SUD) across 10 drug classes including alcohol, cannabis, phencyclidine, other hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other/unknown. Diagnosis is made by specifying the substance of disorder (e.g., alcohol use disorder [AUD]).

26. The DSM-5 diagnostic criteria for a SUD, specified a maladaptive pattern of behaviours related to substance use. These behaviours fall into 11 criteria with overall groupings: impaired control, social impairment, risky use, and pharmacological criteria. For some substances symptoms are less prominent, and in a few instances not all symptoms apply.

27. DSM-5 Diagnostic Criteria for Substance use disorders A problematic pattern of Substance use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period: 1. Consuming the substance in larger amounts and for a longer amount of time than intended. 2. Persistent desire to cut down or regulate use/may have unsuccessfully attempted to stop in the past. 3. Spending a great deal of time obtaining, using, or recovering from the effects of substance use.

28. DSM-5 Diagnostic Criteria cont.. 4. Experiencing craving, a pressing desire to use the substance. 5. Substance use impairs ability to fulfil major obligations at work, school, or home. 6. Continued use of the substance despite it causing significant social or interpersonal problems. 7. Reduction or discontinuation of recreational, social, or occupational activities because of substance use. 8. Recurrent substance use in physically unsafe environments.

29. DSM-5 Diagnostic Criteria cont.. 9. Persistent substance use despite knowledge that it may cause or exacerbate physical or psychological problems. Physical dependence characterized by the phenomenon of tolerance and withdrawal I0 Tolerance, shown by either of the following: a need for increased amounts of the substance to achieve intoxication decreased effect with ongoing use of the same amount of the substance 11. Withdrawal shown by either of the following characteristic withdrawal syndrome of the substance the same or similar substance is taken to relieve or avoid withdrawal symptoms

30. Grouping 1: Impaired control Impaired control over substance use is the first criteria grouping and consists of the first four diagnostic items: the individual may take the substance in larger amounts or over a longer period than was originally intended; the individual may express a persistent desire and/or unsuccessful history to cut down, cease, or regulate substance use; the individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects; and craving is manifested by an intense desire or urge for the drug that may occur at any time.

31. Taking larger amounts than intended. When questioned about the current amount of the substance(s) ingested, the individual discusses experiences where he or she “lost control” or “lost track” and may have felt bad or worried about the excessive substance(s) consumed. For those who qualify for more than one SUD (e.g., cocaine use disorder and AUD), is the larger amount being taken consistent across both substances or only for one substance? For instance, does the loss of control in taking larger amounts of cocaine than intended lead to drinking more alcohol than intended? Though the DSM-5 SUD is the same for each substance class, the clinician still must assess this criteria for each substance. Thus, be careful to verify that the larger amounts than intended criterion is applied to only the proper substance(s).

32. Persistent desire and/or unsuccessful efforts to reduce or cease substance use. The client may discuss a long history of many episodes of brief (less than 1 month) or longer abstinence only to repeatedly relapse. There is no magic number, but look for a history. This may require probing, as the client may not consider their period of nonsubstance use as a period of abstinence. Look for a “motivation” for recovery reported in these prior abstinence episodes. Why did the client start abstinence? Why did he or she relapse? Note that clients may specifically express the reason for starting but may not be able to verbalize why they relapsed. Similar to the prior criterion, was the desire to cut down or cease substance use applicable to all substances or just some?

33. Great deal of time spent acquiring, using substance, and/or recovering from effects. When actively using, how much time is occupied by the substance use?

34. Craving. How has the client experienced the desire to use both now and in the past? If use of multiple substances exists, does craving occur for all or just some of the substances? Do cravings increase or decrease over length of abstinence? Do cravings for one substance influence a craving for another? Do cravings coincide with psychological symptoms (e.g., anxiety, depression)? Do cravings cause guilt or worry in the client? How often in the client’s addiction history has a craving led to a lapse or relapse?

35. Grouping 2: Social impairment Social impairment due to substance use is the second criteria grouping and consists of diagnostic items 5 to 7: (5) recurrent substance use may result in a failure to fulfil major role obligations at work, school, or home; (6) the individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance; and (7) important social, occupational, or recreational activities may be given up or reduced because of substance use.

36. Grouping 3: Risky use Continued risky use of the substance is the third criteria grouping and consists of diagnostic items 8 and 9: (8) the recurrent substance use in situations in which it is physically hazardous (such as driving while intoxicated); and (9) the individual continues substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

37. Grouping 4: Tolerance and withdrawal Tolerance and withdrawal are the final grouping consisting of Diagnostic Criteria 10 and 11: (10) tolerance is signalled by requiring a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when the usual dose is consumed.

38. Intoxication Reversible, substance specific syndrome following recent ingestion of the substance. Causes severe maladaptive behaviour or psychological changes due to the effect on the CNS. It affects one or more of the following mental functions: memory, orientation, mood, judgment and behaviour, social or occupational functioning

39. Substance withdrawal A substance specific syndrome following cessation or reduction of ingestion after heavy & prolonged use. It is characterized by physiological signs & symptoms in addition to psychological changes such as disturbances in thinking, feeling and behaviour. It may cause significant distress or impairment.

40. Withdrawal, Diagnostic Criteria 11, is a syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing withdrawal symptoms, the individual is likely to consume the substance to relieve the symptoms. Withdrawal symptoms vary greatly across the classes of substances, and separate criteria sets for withdrawal are provided for the drug classes. In general, withdrawal syndromes must cause impairment and distress as well as not be better explained by a co-occurring psychological and/or medical disorder (this includes symptoms due to intoxication from the same substance or withdrawal from another substance).

41. DSM V diagnostic criteria: Alcohol-related disorders A problematic pattern of alcohol use leading to clinically significant impairment or distress evidenced by at least 2 of the following during the last 12 months Alcohol often taken in larger amounts and over a longer period than intended. There is a persistent desire or unsuccessful effort to cut down on use. A great deal of time is spent on activities involved in obtaining, using or recovering from alcohol use

42. DSM -V diagnostic criteria: Alcohol-related disorders cont’d Craving Causing significant impairment in social roles Recurrent use of alcohol where it is physically dangerous Continued use despite having major problems caused or exacerbated by alcohol use Important recreational, occupational or social activities are given up because of alcohol use

43. DSM -V diagnostic criteria: Alcohol-related disorders cont’d Use continues despite knowing that alcohol causes problems Tolerance Withdrawal

44. Alcohol dependence WHO (1990) defines alcohol dependence as excessive drinking where dependence to alcohol is evident in psychological deviations with physical and mental health, interpersonal relationships and smooth social and economic functioning. Excessive : more than 150ml whisky, 937 ml wine or 3,000 ml beer per day

45. Features of alcoholics Drink compulsively without restraint Have been drinking for a long time Drink until intoxicated Drinking pattern has negative influence on interpersonal functioning

46. Development of an alcoholic steps in the development of an alcoholic 1. Pre-alcoholic phase: first episodic and later constant drinking in response to stress. Alcohol tolerance increases. 2. Prodromal (early alcoholic)phase: blackouts, secret drinking, preoccupation with alcohol , guilt feelings about drinking and refuses to discuss about drinking problem

47. Development of an alcoholic 3. Crucial phase—loss of control over drinking, rationalizes behaviour, paranoid and aggressive, remorse, repeated attempts to control drinking, problems at work and family, interest in other things begins to diminish, tremors, needs “pick-me-up” in mornings. 4. Chronic phase: deteriorates physically and morally, thoughts impaired; obsession with alcohol

48. DSM-V Diagnostic Criteria (Alcohol Intoxication) A. Recent ingestion of alcohol. B. Clinically significant problematic behavioural or psychological changes( e.g.,inappropriate sexual or aggressive behaviour, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. C. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus (condition whereby the eyes make rapid, repetitive uncontrolled movements). 5. Impairment in attention or memory. 6. Stupor or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

49. Alcohol Withdrawal DSM-5 (APA, 2013) Criteria Review: Withdrawal symptoms must include two or more of the following occurring within a few days post last drink: Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). increased hand tremors, insomnia, Nausea and or vomiting Transient visual, tactile, or auditory hallucinations or illusions. psychomotor agitation, Generalised tonic- clonic seizures (a seizure affecting the entire brain), anxiety. Withdrawal is only diagnosable if there is moderate or severe alcohol use disorder.

50. Alcohol Withdrawal cont’d cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Specify if: With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium.

51. Cannabis Withdrawal DSM-5 Criteria Review: Withdrawal symptoms must include three or more of the following occurring within one week of last use: Irritability/anger, anxiety/general nervousness, sleep difficulties, decreased appetite, restlessness, depression, and somatic symptom such as abdominal pain or headache. Withdrawal is only diagnosable if there is moderate or severe cannabis use disorder .

52. Opioid Withdrawal DSM-5 Criteria Review: Withdrawal symptoms must include three or more of the following occurring within a few minutes to a few days post last use: Depressed mood, nausea, body aches, lacrimation (excessive tears) or rhinorrhea (excessive nose running), pupil dilation or sweating,

53. Cont. diarrhea, yawning, fever, insomnia. Withdrawal is only diagnosable if there is a moderate or severe opioid use disorder

54. Sedative, Hypnotic, or Anxiolytic Withdrawal DSM-5 Criteria Withdrawal symptoms must include two or more of the following occurring within a few hours to a few days post last use: Pulse rate greater than 100 beats/minute, hand tremor, insomnia, nausea, auditory hallucinations, psychomotor agitation, anxiety, clonic -tonic seizure. Withdrawal is only diagnosable if there is a moderate or severe sedative, hypnotic, or anxiolytic use disorder. Notice the similarity between withdrawal symptoms from alcohol and sedative, hypnotic, or anxiolytic substances.

55. Stimulant Withdrawal DSM-5 Criteria Withdrawal symptoms must include dysphoric mood and two or more of the following occurring within a few hours to a few days post last use: Fatigue, unpleasant vivid dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation. Withdrawal is only diagnosable if there is a moderate or severe stimulant use disorder .

56. Severity ratings In DSM-5 (APA, 2013), SUDs are now rated on a continuum of severity based on the number of diagnostic criteria (out of 11) endorsed via client self-report (e.g., interview or screening/assessment), clinician observation, collateral report (e.g., family or friends), and/or biological (e.g., urine) testing. The ratings run from mild (two to three criteria endorsed), moderate (four to five criteria endorsed), and severe (six or more criteria endorsed).

57. Course specifiers Though some individuals may come to the diagnostic process as actively using, others may already be in some degree of recovery. Therefore, beyond the type and severity of diagnosis, DSM-5 also provides the diagnostician an opportunity to specify details regarding any period of abstinence. Early remission occurs if the individual had met the full SUD criteria but now has gone between 3 and 12 months without experiencing any of the diagnostic criteria with the exception of craving. Sustained remission occurs if the individual had met the full SUD criteria but now has gone greater than 12 months without experiencing any of the diagnostic criteria with the exception of craving.

58. harmful use requiring physical or mental harm dependence, which requires a minimum of three of the following six criteria endorsed: Strong desire or compulsion to use the substance (this may entail craving). Difficulties in controlling substance use in terms of onset, termination, or level of use. Withdrawal or using the same substance to relieve or avoid withdrawal symptoms. Tolerance. Neglect of alternative pleasures or time spent to obtain, use, and recover from use. Continued use despite having a physical, psychological, or cognitive problem(s) related to substance use.

59. Co-Occurring Psychiatric Disorders Diagnosis of substance-induced psychiatric disorders substance-induced anxiety disorders, substance-induced depressive disorders, substance-induced bipolar disorders, and substance-induced psychotic disorders.

60. Activity 4 W.R is a 30 years old man. Client was referred by his employer, for psychological assessment and management of the problem of client. The client was presented with the complaints of stealing habit, poor problem solving, poor abstract reasoning, and poor communication skills. Create a case scenario to equip your interviewing, screening and assessment skill, Describe your anticipated interview, screening and assessment and diagnosis of this client

61. Discussion Identifying Information Sources and Reason for Referral Presenting Complaints and Initial observation History of Present Problems Background Information: Personal history, Substance use history Past medical/ Psychiatric history, Educational history, Occupational History, Sexual history

62. History of Family substance use, Psychiatry/ Medical Illness Social support, Spirituality and Religion, 12- step affiliation, Coping skills Mental Status Examination Physical examination Drug abuse screening and test-bloods if intoxication is suspected Provisional DSM5 diagnosis including the grouping and severity