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Addiction Counseling Tools: The MSE – Mental Status Exam

The Mental Status Exam (MSE)

The Mental Status Exam is part of the assessment process. Skillful counselors and therapists are able to identify clients with co-occurring disorders. Well-trained substance abuse counselors and therapists can provide a more competent service when they possess the basic knowledge in mental disorders that co-occurred with substance abuse problems. The following is a brief outline of the MSE.
1. The Mental Status Exam (MSE)

  •  It is the process of noting the observable in some systematic way
  • It is different from the biopsychosocial assessment
    • Based mostly on facts about the client’s life
    • Description of the problem provided by the client
  • The MSE is basically our observations
  • It’s a very useful tool for assessing a client over time

2. Helpful questions for the MSE

  • What has changed?
  • When did it change?
  • Has it change for the better or the worse?
3. Two things to keep in mind
  •  Ask for further explanation when you don’t understand something the client has told you
  • Document what is worth noting
 4. Where to begin
  •  Start by describing those things that anyone looking at the client would notice
  • It does not matter when the MSE is completed
  • Remember that a good clinician is a good observer
 5. Avoid two real temptations
  • To infer meaning from what you are actually seeing
  • To see things that are in reality just your assumptions
 6.  Areas to address in the MSE
  •  Appearance
    • How does the client look and behave?
  • Speech
    • How does the client speak?
  • Emotions
    • What is the client’s mood/affect?
    • How does the client feel most of the time?
    • How does the client appear to be feeling during the interview with you?
  • Thought process and content
    • How does the client think?
      • Circumstantiality – takes a while to get to the point
      • Perseveration – repeating phrase or returning to same subject
      • Association – how does the client get from one idea to the next?
  • What does the client think about?
    • Delusions?
    • Compulsions?
  • Sensory perception
    • Illusions?
    • Hallucinations?
  • Mental Capacities
    • Is the client oriented in time, place, and person?
    • What is your estimate of the client’s intellingence?
    • Can the client remember and concentrate?
    • How are the client’s judgment and insight?
  • Attitude toward the interviewer
    • Client’s attitude towards you
    • Does it change over time?
    • Does he/she respond to empathy?
    • Does he/she appear to be capable of empathy?

Reference: Where to Start and What to Ask – Susan Lukas. (This is by far one of my favorite books. I highly recommend it) 
 Dual Disorders – David O’Connell


  1. Tim Prentice says:

    It looks like this is my second time posting.For some reason the first didn”t go through. The theoretical concept paper went well. I recieved a good grade, and made a good stance on my model of addiction. It was sound, wel documented and cited, and proved above all that the approach well matched, disease model with the bio psycho social spiritual approach. This may be a paper to further develop later. Thought you would be interested in knowing.


    • Good job!! I’m so glad to hear that, Tim. You chose a good combination of approaches to treatment and you can definitely go into more depth about this in the future. I really like the holistic approach and in combination with other theories they are the best tools substance abuse counselors can have to treat dual diagnosis clients. Thanks for your message!

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