In order to provide a competent practice, addiction counselors need to learn and understand the 8 Practice Dimensions and the knowledge, skills, and attitudes associated with each of them.

Clinical Evaluation

Clinical evaluation is a systematic approach to recognizing and diagnosing substance abuse problems, including the potential for co-occurring mental disorders.

There are two elements included in the clinical evaluation process:

• Screening
• Assessment

Screening

Screening allows us to review the client’s current situation, including symptoms and other information, in order to determine the most appropriate course of action, taking into consideration the needs and characteristics of the client and the resources available within the community.

This is basically the first interaction between the client and significant others, and the counselor. It is very important how this first interaction is conducted.

Our goal is to establish rapport with our client and her/his significant others. We need to know:

• Why it is important to build rapport.
• The purpose of building rapport.
• The range of human emotions and feelings.
• What constitutes a crisis.
• How to prevent and manage a crisis situation.
• How to identify situations and conditions when additional professional assistance is necessary.
• Sources of assistance available.

The way in which we interact with our client is very important. The client may be experiencing anxiety, anger, fear, going through withdrawals, etc. Here is what we need to do:

• Demonstrate effective verbal and nonverbal communication.
• Identify the client’s beliefs.
• Reflect the client’s feelings and message –Active listening.
• Recognize dangerous situations.
• Treat the client with empathy, respect, and genuineness – Unconditional positive regard.

Gathering Information

Screening is a data-gathering process. Data is gathered from the client and other sources such as family, friends, employer, and coworkers. There are different screening instruments and we must select the ones that are sensitive to age, developmental level, culture, and gender. The data we will gather should include a history of current and past substance use/abuse and  substance abuse treatment; physical and mental health; mental and functional statuses; and current socio-economic and environmental problems.

A competent substance abuse counselor must have knowledge in the following:

• Validated screening instruments for substance abuse and mental status.
• Purpose, application, and limitations of those instruments.
• Reliability and validity.
• How to administer and score screening instruments.
• Interpretation of results.
• How to communicate effectively during emotionally charged situations.
• How to write accurately, concisely, and legibly.

The screening process includes determining whether a client is appropriate and eligible for admission into a particular program, so we need to be familiar with:

• Symptoms of intoxication, withdrawal, and toxicity for all psychoactive substances, alone and in combination with others.
• The physical pharmacological, and psychological effects of substance use.
• Acute and Chronic effects.
• Available resources for help with drug reactions, withdrawal, and violent behavior.
• Options, limitations, and legal implications of toxicity screening.
• Meaning of toxicology reports.
• Toxicology language.
• Relationship between psychoactive substance use and violence.
• Diagnostic criteria for suicide risk and danger to others.
• Mental and physical conditions that overlap symptoms of drug intoxication and withdrawal.

Working with  the client during the screening process includes helping the client identify the effects of substance use or abuse on her/his current life problems. A very useful tool is Motivational Interviewing (MI). MI will help us assess the client’s readiness to address substance abuse issues; interpret the client’s perception of her/his experiences; and assess the client’s stage of change.

Substance abuse counselor must be familiar with:

• Denial and other defense mechanisms.
• Stages of readiness.
• Stages of change
• Treatment options and their philosophies.
• The client’s needs and preferences.
• Available resources for admission and referral.

Assessment

TAP 21