Home » Counselor Intern » ASAM Dimension 2 – Biomedical Conditions and Complications

ASAM Dimension 2 – Biomedical Conditions and Complications

Contributor: Yvette McBride Thomas

Dimension 2: Biomedical Conditions and Complications

Problems (need)

  • Patient has a medical condition (e.g. high blood pressure, asthma, diabetes, etc.) and has not consistently participated in recommended medical care.
  • Patient has a serious illness and needs to continue medical care with his/her primary care physician/specialist
  • Patient is pregnant and needs to engage in regular high risk prenatal care
  • Patient is in need of dental treatment
  • Patient is in need of prophylactic for treatment /prevention of active TB
  • Patient is in need of healthcare information on HIV/AIDS, TB, and Hep that include the effects of illicit drugs on the body.
  • Patient is in need of CXR after positive PPD (TB)
  • Patient is in need of HIV education as part of preventive care
  • Patient needs to engage in regular preventive medical care
  • Biomedical condition may be exacerbated by illicit drug/alcohol use.
  • A positive test for HIV/AIDS
  • Patient has a history of neglecting his/her physical and medical health

Goal (I will)

  • Secure medical care
  • Engage in regular medical care for management of chronic medical condition
  • Continue specialized treatment for serious medical condition
  • Secure high risk prenatal care
  • Secure dental care
  • Receive screening and/or treatment for prevention of active TB
  • Learn effects of illicit use on medical condition
  • Participate in regular prevention medical care
  • Ensure coordination of care including primary medical provider and treatment provider
  • Medically stabilize physical condition
  • Accept chronic medical condition with proper medical attention given to it
  • Take responsibility for maintain physical health and well being
  • Establish chemical dependency recovery that leads to improved physical health

Intervention (objective)

  • Patient to secure medical appointment with primary care physician to follow up on abnormal labs within one month or earliest available appointment
  • Patient to discuss in counseling session the benefits of complying with recommended medical care; monitor on going medical compliance
  • Patient to verify available coverage and report back to staff: verify medical coverage as needed and offer patient appropriate referrals based on source of coverage.
  • Patient to become aware of negative effects of illicit drug use on biomedical condition after reviewing in counseling: address ongoing through course of treatment.
  • Patient to register all prescription medication and update prescription verification throughout course of treatment
  • Patient to use referral list and call for dental appointment: target date one month or first available appointment
  • Patient to bring verification of attendance at high risk prenatal clinic: monthly throughout the course of pregnancy
  • Patient to be able to name benefits of regular prenatal care: address in counseling throughout period of pregnancy
  • Patient to become aware of illicit drug/alcohol abuse/use on pregnancy: address in counseling session throughout period of pregnancy
  • Patient to receive HIV/AIDS as well as TB risk reduction education: target date within six(6) weeks of entering treatment and update as needed throughout the course of treatment
  • Patient to attend post-partum medical appointment within eight (8) weeks of delivery or first available appointment
  • Treatment staff to consult with patient primary medical doctor as needed to ensure ongoing appropriate care
  • Patient to discuss importance of preventive medical care for self and family
  • Patient to bring in verification of TB screen (PPD)
  • Patient to bring verification of prophylactic treatment for prevention or treatment of active TB

Diagnostic Suggestions (taken from DSM-IV codes associated with presenting problems)

  • Axis 1

303.90 Alcohol Dependence

304.20 Cocaine Dependence

304.80 Polysubstance Dependence

Behavioral Definitions

  • A positive test for HIV/AIDS
  • History of neglecting his/her physical and medical health
  • Medical complications secondary to chemical dependence

Long Term Goals

  • Accept chronic medical conditions with proper medical attention given to it
  • Take responsibility for maintaining physical health and well-being
  • Establish chemical dependence recovery that leads to improved physical health

Therapeutic Interventions

  • Make any necessary arrangements required for patient to obtain the medical services needed
  • Refer patient to physician for complete physical
  • Help patient understand his/her medical problem and the need to cooperate with doctor’s recommendations
  • Monitor treatment effectiveness and document patient’s follow-through on doctor’s orders; redirect when patient is failing to comply
  • Consult with physician and review doctor’s orders with patient
  • Provide patient with any appropriate  literature that will increase his/her understanding of medical condition
  • Arrange for consultation with dietitian to explain proper nutrition that will enhance medical recovery
  • Explore and assess the role of chemical abuse/dependency has on medical condition
  • Refer patient to public health of physician for STD and/or HIV testing, education and/or treatment
  • Help patient identify and express his/her feelings connected with medical condition
  • Assign patient to make a list of things he/she could do to help maintain physical health; process list

Progress Note:

Note: each note ins is the order of the therapeutic intervention

  • The patient presented with serious medical problems that are having a negative impact on his/her daily living
  • The patient has pursued/refused treatment for his/her medical condition
  • The patient has not sought treatment for his/her medical condition because of a lack of insurance and financial resources
  • The patient’s serious medical condition has been under treatment and is showing signs of improvement
  • The patient reports that he/she has tested positive for HIV/AIDS
  • Patient has been HIV positive for several months but has had no serious deterioration in his/her condition
  • The patient is obtaining consistent medical care for his/her HIV status
  • The patient has refused medical care for his/her HIV-positive status and tends to be  in denial about seriousness of this situation
  • The patient’s HIV-positive status has resulted in the development of AIDS
  • Because of the patient’s chronic chemical dependency history, he/she has developed medical complications
  • The patient has accepted that he/she has deteriorated medically because of his/her chemical dependency pattern and has terminated substance abuse
  • The patient is in denial about the effects of his/her substance abuse and continues this self-destructive pattern
  • The patient’s medical condition has improved subsequent  to termination of substance abuse
  • The patient described a history of neglecting his/her physical and medical problems
  • The patient continues to refuse medical evaluation and treatment for physical problems
  • The patient agrees to seek medical treatment and has followed through on this recommendation
  • After receiving medical treatment, the patient’s physical and medical condition has improved significantly.


Reference: Jongsma, A.E. Jr and Peterson, L. Mark The Complete Adult Psychotherapy Treatment Planner 2nd edition
Suggested Reading
Substance Abuse Treatment for Persons with HIV/AIDS. Treatment Improvement Protocol (TIP) Series, No. 37.
  • The National AIDS Treatment Information Project – http://www.natip.org/index.html
  • The Measurement Group – www.themeasurementgroup.com
  • JAMA HIV-AIDS information center – http://www.ama-assn.org/special/ hiv/hivhome.htm
  • Critical Path AIDS Project – http://www.critpath.org/critpath.htm
  • HIV/AIDS Treatment Information Service (ATIS) – http://www.hivatis.org
  • AIDS Clinical Trial Information Service (ATCTIS) – http://www.actis.org
  • Centers for Disease Control and Prevention (CDC) – http://www.cdc.gov

Enter your email address to follow this blog and receive notifications of new posts by email.

Join 1,056 other subscribers
%d bloggers like this: