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Treating Substance Abuse/Addiction (Part II)

Contributor: Yvette McBride Thomas

Treating Illegal Drug Addiction

  • Around half a million Americans are heroin addicts, and four million are regular users of marijuana.
  • Treatment is often based on the AA model.
  • Because of incarceration of illegal drug abusers, jail is the usual context for treatment.
  • “Stay’n Out” is a prototype of a jail treatment program that works well and has a recidivism rate of only 25%.

Treating Families where there is Substance Abuse/Addiction

  • Families either promote or enable substance abuse behaviors. The whole family has to be included in the treatment.
  • Children with chemically dependent parents are at risk.
  • Alcoholic families tend to be isolated and lack positive role models.
  • Young people from dysfunctional families use substance abuse to
    • Relieve stress and anxiety and structure time.
    • Keep their minds off family dynamics and on predictable problematic behaviors.
    • Substitute for sex and promote pseudo-individuation (a false sense of self).

Treatment Services

  • Counselor can provide information.
  • Counselor may have to be confrontational with the family over the effects of substance abuse on the family and individual. An intensive systems approach must be used that also involves agencies.
  • Counselor can work to help family deal with feelings, such as anger and defense mechanisms.
  • Counselors can also help the family take responsibility for their behaviors.
  • Developmental issues are also worked on by the family.

Treating Women and Minority Cultural Groups in Substance Abuse

  • Approximately five to seven million women abuse alcohol in the US alone.
  • Women face societal rebuke and chastisement for alcohol abuse.
  • Barriers to treatment include need for childcare, cost, family opposition, and inadequate diagnosis.
  • Little evidence exists on the benefits of AA and NA on the one-third of the AA membership that women represent due to gender differences and cultural differences.
  • “Women for Sobriety” is an alternative help group program that is based on a cognitive-behavior modification approach. Thinking is changed to overcome feelings of helplessness, powerlessness, guilt, and dependence.
  • Cultural differences may play a part in the recovery process. Spiritual elements may be different for women and different ethnic backgrounds.

Affiliation, Certification, and Education of Substance Abuse Counselors

IC&RC

  • The International Certification & Reciprocity Consortium.
  • IC&RC’s credentials include
    • Alcohol and Drug Counselor (ADC)
    • Advanced Alcohol and Drug Counselor (AADC)
    • Clinical Supervisor (CS)
    • Prevention Specialist (PS)
    • Certified Criminal Justice Addictions Professional (CCJP)
    • Certified Co-Occurring Disorders Professional (CCDP)
    • Certified Co-Occurring Disorders Professional Diplomate (CCDPD)
    • The IC&RC is currently developing a Peer Mentor (PM) credential.

TCBAP

  • Texas Certification Board of Addictions Professionals

• IAAOC

  • International Association of Addictions and Offender Counseling
  • Focuses on the prevention, treatment, and description of abusive and addictive behaviors.
  • Publishes the Journal of Addictions & Offender Counseling

• NAADAC

  • National Association of Alcoholism and Drug Abuse Counselors
  • A national organization that certifies addiction counselors

• NBCC

  • In 1994 the National Board of Certified Counselors added a certification process for becoming a substance abuse counselor.

Two types of counselors

  • Recovering counselors
  • Nonrecovering counselors
Reference:
Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.

Treating Substance Abuse/Addiction

Contributor: Yvette McBride Thomas

Characteristics

  • About 25% of counseling cases relate to substance abuse and addiction.
  • Substance abusers have dysfunctional dynamics making them difficult to work with.
  • Three most common ways counselors work with addicted persons include outpatient, residential, and inpatient.
  • Addicts must be “dry” or “dried out” for 30 days or more to give them a “clean” body and mind to use in doing something different and positive.
  • Alcoholic family systems have an overresponsible/underresponsible phenomenon.
    • Over-responsible people are codependent and seek to control others and feel inadequate when faced with disappointments but are easier with whom to work in counseling situations.
    • Underfunctioning people are less motivated to change.

Factors Affecting Treatment include:

  • Motivation – Most substance abusers/addicts do not desire to change and are self-centered and are comfortable where they are.
  • Denial – is minimizing the effects of substance abuse/addiction on either oneself or others.
  • Dual Diagnosis – An abuser/addict has more than one aspect of personality that needs treatment (i.e., addiction and depression).
  • Matching – Finding the right treatment for a disorder.
  • Control – the regulation of a behavior
  • Relapse – the reoccurrence or recidivism of dysfunctional behaviors one they have been treated.

Treatment Strategies for Individuals

  • Motivational Interviewing (MI) is used to lower resistance in substance abuse/addiction cases.
    • This approach draws from person-centered counseling and includes such skills as active listening, reflection, and reframing.
  • Bibliotherapy
    • Bibliotherapeutic approach may work with some individuals.
    • Abusers and addicts read books or view/listen to media and discuss ideas related to what they have experienced.
  • Cautions to remember for counselors working with adolescents regarding alcohol and substance use:
    • Working with adolescents is a treatment specialty.
    • Family and significant people in their lives should be included for counseling to be effective.
    • Adolescents need to be educated about what counseling is.
    • Therapeutic techniques need to be specifically tailored to adolescents.
    • Counselors cannot function as the adolescent’s friend.
    • Counseling focus should be centered on problem solving, skill building, and just being heard.
    • “Therapeutic moments” are more uneven with adolescents.

Specific Treatments

  • Treating Alcohol Abuse/Addiction – Alcoholics Anonymous (AA)
  • Background of AA
    • AA is the oldest successful treatment program in the world and was founded in the 1930s.
    • AA is a fellowship and a rehabilitation program.
    • Alcoholics have “character defects” that “are feelings, beliefs, and behaviors that dispose them to seek a sense of well-being by abusing alcohol.
    • Meetings are conducted with small groups and literature.
    • Key component in AA
    • A 12-step program that has its basis on a spiritual foundation
    • Group discussions center on the need and availability of support of others and a dependence on a higher power.
    • Members are never “cured;” rather they are “in recovery.”
    • Emphasis is also given to responsibility, forgiveness, restitution (when possible), affirmation, ritual, and fellowship.

Treating Nicotine Addictions

  • Over 25% of Americans smoke cigarettes, three million of whom are adolescents.
  • About 80% of those who abuse or are addicted to alcohol smoke.
  • Most nicotine dependent people are not successful as a group in their goal of smoking cessation.

Successful techniques for counselors

Telephone counseling

  • Counseling consists of a 15- to 30- minute phone call where counselors give positive, nonjudgmental feedback to those who are trying to quite smoking.
    • The goal is to promote self-efficacy.
  • Rapid smoking
    • After counseling, smokers go through a series of six 1-hour sessions where they inhale a cigarette every 6 seconds until they feel too sick to continue.
    • The goal is to produce a conditioned negative response to the taste of cigarettes.
  • Skills training
    • Coping skills are taught after clients have learned to recognize the triggers that produce the urge to smoke.
  • Most successful skills taught:
    • Self-statements about the financial and health benefits of discontinuing smoking
    • Oral substitutes
    • Increased physical activity
    • Buddy system

Treating Substance Abuse/Addiction Part II

DYI! Get ready with me.Samantha DeLint - Youtube Channel

DYI! Get ready with me.
Samantha DeLint – Youtube Channel

Preventing Substance Abuse/Addiction

Contributor: Yvette McBride Thomas

Prevention Programs

“Just Say No”

  • Sponsored by local governments and found in schools and public agencies.
  • The program’s message is incorporated into public service announcements on television to influence preteens and teens by their peers to say “no” when offered a cigarette or other addictive or dangerous substance.

D.A.R.E.

  • Drug Abuse Resistance Education
  • Found in late elementary and early middle school grades
  • Uses police as instructors and provides case scenarios that challenge fifth and sixth graders to think about and answer them.

S.A.D.D. and M.A.D.D.

  • Students against Drunk Driving
  • Mothers against Drunk Driving
  • These associations help educate and orient young people about the hazards of drug abuse and the dangers of addiction

Tobacco and Cocaine Programs

  • These programs focus on the external and internal factors important to teens. External factors
  • External factors include: breath, teeth, clothes, and costs.
  • Internal factors include: lifestyle choices, time management, and nutrition.
  • Group pressure and dynamics are common elements in prevention.
  • Adolescents who get involved in the use of drugs do so because of friends who use drugs.
  • When a group perceives drugs as hazardous, its members are less likely to engage in the behavior.
  • Educational and support groups are a valuable tool to help ward off abuse and addictive behaviors
Reference:
Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.

Understanding Substance Abuse and Addiction

Contributor: Yvette McBride Thomas

Intrapersonal Abuse and Addiction

  • Intrapersonal abuse involves the misuse of objects or substances that were produced for one purpose, such as healing (prescriptive medication) or entertainment (video games), but are exploited excessively to the detriment of the person involved.
  • The result is that often an addiction (a state of physiological or psychological dependence) occurs with excessive amounts of time and effort being devoted to the object or substance.
  • Three C’s of addiction conceptualize its core characteristics: loss of control over addictive behaviors; compulsive use; and continued use regardless of negative consequences.

Substance Abuse and Addiction

  • The habitual misuse of intoxicating and addicting substances, such as alcohol, drugs, and tobacco.
  • Drugs – any substance other than food that can affect the way a person’s mind and body works, including stimulants, depressants, and hallucinogens.
  • Abuse and addiction cause mental, physical, emotional, social, and spiritual damage.
  • A major public health issue found across all demographic areas.

The Nature of Substance Abuse and Addiction

  • Occurs frequently as a mental health problem in the US.
  • One of 10 adults in the US has a significant problem related to alcohol use.
  • Alcohol abuse/addiction is believed to be greater among Native Americans.
  • A significant percent of patients who are hospitalized abuse alcohol.
  • Health care costs are doubled among alcoholic families.
  • Drug abuse/addiction among adolescents affects development and well-being more than crime, social pressure, grades, or sex.
  • Approximately 3 million teenagers are addicted to or abuse alcohol,
  • Half a million are marijuana users, and
  • One out of 10 teenagers has tried cocaine.
  • Substance abuse/addiction affects more than just the individual.
  • Other than the abuser, up to four others are being adversely affected including family members, friends, or associates.

Polysubstance abuse/addiction

  • Abuse of two or more substances at the same time is a growing problem.
  • Social conditions may evoke other substance abuse/addiction, such as smoking.
  • Conditions related to smoking
    • Unsatisfactory life rooted in poverty and hopelessness
    • Peer pressure
    • Poor school performance
    • Parental smoking
    • Minority ethnic status
    • External locus of control
  • Addiction
    • A behavior pattern with biological, psychological, sociological, and behavioral components .
    • A persistent and intense involvement with and stress upon a single behavior pattern, with a minimization or even exclusion of other behaviors, both personal and interpersonal.
    • Addiction is characterized as a preoccupation with one object that controls behaviors and limits other actions over time.
  • Reference:
    Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.

     

    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.
     INFORMATION SOURCES
    • 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

    ASAM Dimension 1 – Acute Alcohol and/or Drug Intoxication

    Contributor: Yvette McBride Thomas

    Dimension 1:  Acute Alcohol and/or Drug Intoxication

    Problems: (need)

    • Patient presents with opiate withdrawal symptoms
    • Patient reports continued opiate dependency for ____ years and urine toxicology confirms opiates in system
    • Patient reports pattern of acute  cocaine intoxication
    • Patient reports/evidence episodic alcohol intoxication
    • Patient reports pattern of THC abuse or dependency
    • Patient is opiate dependent and in need of continued outpatient methadone treatment
    • Patient has been maintained in OMT and patient in consult with staff have determined he/she is ready for therapeutic detoxification
    • Patient shows  signs of continued opiate use on current methadone dosage

    GOALS (I will)

    • Stabilize on methadone maintain dosage
    • Cease use of illicit opiates as evidence by urine screen results
    • Cease use of alcohol
    • Cease use of non-narcotic illicit drugs as evidence by urine results
    • Successful therapeutic detoxification from methadone/methadone
    • Continued stability o OMT

    INTERVENTION (objective)

    • Medical review of history and physical by MD: target date within 72 hours of admission
    • Begin induction of methadose and monitor for needed dose adjustments. Patient to be observed at dosing 6x per week initially and patient to report any symptoms of intoxication or withdrawal to medical personnel: target date for dose stabilization: three weeks and monitoring ongoing
    • Patient to be randomly breathalyzer for monitoring due to history of ETOH abuse: target randomly breathalyzer throughout the course of treatment
    • Patient to have a urine toxicology screen within six (6) weeks of treatment to monitor for evidence of illicit drug use/pattern of intoxication and random urine screens per FDA regulations throughout treatment
    • Counselor and medical team to consult MD to order appropriate therapeutic detox plan
    • Patient to monitor self during therapeutic detox and report any symptoms to staff for MD review
    • Counselor to discuss possible need for increase in meth dose with patient and document on medical review
    • MD to review patient urine screens and symptoms for possible meth dose change per medical review

    DIAGONOSTIC SUGGESTIONS (taken from DSM-IV codes associated with presenting problems)

    • AXIS 1

    303.90 Alcohol Dependency

    305.00 Alcohol Abuse

    304.30 Cannabis Abuse

    304.20 Cocaine Dependence

    305.60 Cocaine Abuse

    304.80 Polysubstance Dependence

    BEHAVIORAL DEFINITIONS

    • Consistent use of alcohol or other mood-altering drugs until high, intoxicated, or passed out
    • Inability to stop or cut down use of mood altering drug once started, despite the verbalized desire to do and the negative consequences continued use brings
    • Denial that chemical dependence is a problem despite direct feed-back from spouse, relatives, friends and employers that the use of the substance is negatively affecting them and others
    • Amnesiac blackouts have occurred when using alcohol
    • Increase tolerance for the drug as there is the need to use more to become intoxicated or to attain the desired affect
    • Continued alcohol/drug use despite experiencing persistent or reoccurring physical, legal, vocational, social, or relationship problems that are directly caused by the use of drugs/alcohol

    LONG TERM GOALS

    • Accept chemical dependency and begin to actively participate in a recovery/support program
    • Establish a sustained recovery, free from the use of all mood-altering substances.
    • Establish and maintain total abstinence while increasing knowledge of the disease and the process of recovery
    • Acquire the necessary skills to maintain long-term sobriety from all mood-altering chemicals
    • Withdraw from mood-altering substance, stabilize physically and emotionally, and then establish a supportive recovery plan

    THERAPEUTIC INTERVENTIONS

    • List recreational and social activities and places that will replace substance abuse related activities
      • Assist client in developing insight into life changes needed in order to maintain long term sobriety
      • Assist client in planning social and recreational activities that are FREE from association with substance abuse
      • Write a good-bye  letter to drug of choice telling it why it must go
        • Direct patient to write a good-bye letter to drug of choice; read it and process related feelings with counselor/therapist.
        • Ask client to make a list of the ways substance abuse has negatively impacted his/her life and process it with therapist

    PROGRESS NOTE

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

    Consistent abuse of alcohol/drug

    • The patient described a history of alcohol abuse on a frequent basis and, often, until intoxicated or passed out
    • Family members confirmed a pattern of chronic abuse by the patient
    • The patient acknowledges that his/her alcohol abuse began in adolescence and continued into adulthood
    • The patient has committed him/herself to a plan of abstinence from alcohol/drugs and to participate in a recovery/support program
    • The patient has maintained total abstinence, which is confirmed by his/her family

    Inability to reduce alcohol/drug abuse

    • The patient acknowledges that he/she frequently has attempted to terminate or reduce usage of the mood/mind altering substance, but has found that once use has begun, he/she is unable to follow through.
    • The patient acknowledges that in spite of negative consequences and a desire to reduce or terminate the use of drugs/alcohol he/she is unable to do so.
    • As the patient has participated in a total recovery program, he/she has been unable to maintain abstinence.

    Denial

    • The patient presented with denial regarding the negative consequences of his/her substance abuse, inspite of direct feedback from others about its negative impact
    • The patient’s denial is beginning to breakdown as he/she is acknowledging that substance abuse has created problems in his/or life
    • The patient now openly admits to the severe negative consequences in which substance abuse has resulted

    Amnesiac blackouts

    • The patient has experienced blackouts during alcohol abuse, which have resulted in memory loss for periods of time in which the patient was still functional
    • The patient stated that his/her first blackout occurred at a young age and that he/she has experienced many of them over the years of his/her alcohol abuse
    • The patient acknowledged only one or two incidents of amnesiac blackouts
    • The patient has not had any recent experiences of blackouts, as he/she has been able to maintain sobriety

    Increase tolerance

    • The patient described a pattern of increasing tolerance for the mood-altering substance as he/she needed to use more of it to obtain the desired affect
    • The patient described the steady increase in the amount and frequency of the substance abuse as his/her tolerance for it increased

    Continued alcohol/drug use

    • The patient has continued to abuse alcohol/drugs in spite of recurring physical, legal, vocational, social, or relationship problems that were directly caused by the substance use
    • The patient has denied that the many problems in his/her life are directly caused by alcohol/drug abuse
    • The patient acknowledged that alcohol or drug abuse has been the  cause of multiple problems in his/her life and verbalized a strong desire to maintain a life free from using all mood-altering substances
    • The patient is now able to face resolution of significant problems in his/her life as he/she has begun to establish sobriety
    • As the patient has maintained sobriety, some of the direct negative consequences of substance abuse have diminished
    REFERENCE USED: Jongsma, A.E. Jr and Peterson, L. Mark The Complete Adult Psychotherapy Treatment Planner 2nd edition

     

    SUGGESTED READING
    Alcoholics Anonymous (1975). Living Sober. New York: A.A. World Services
    Alcoholics Anonymous (1976). Alcoholics Anonymous: The Big Book. New York: A.A.  World Services
    Carnes, P. (1989).  A Gentle Path Through the Twelve Steps. Minneapolis, MN: CompCare.
    Nuckals, C. (1989) Cocaine: From Dependency to Recovery. Blue Ridge Summit, PA: TAB Books

    Diagnosis

    Contributor: Yvette McBride Thomas

    Diagnosis— the meaning or interpretation that is derived from assessment information and is usually translated in the form of some type of classification system.

    • A description of a person’s condition and not a judgment of a person’s worth
    • A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are mental disorders that people have. For this reason, the text of DSM-IV…avoids the use of such expressions as ‘a schizophrenic’ or ‘an alcoholic’ and instead uses the more accurate, but admittedly more cumbersome, ‘an individual with schizophrenia’ or ‘an individual with alcohol dependence’” (DSM IV-TR, APA, p. xxxi).
    • Diagnoses are important for:
      1. Insurance company reimbursement
      2. Developing a proper treatment plan
      3. To be able to communicate with other professionals, counselors must be able to speak about, understand, or report a client diagnosis
    • Diagnostic decisions are an evolving process and not a static event.
    • Diagnosis and treatment planning are now such standard components of counseling practice that a failure to diagnose on some level or a lack of professional diagnostic training may be construed as unethical (p. 335).

    Nota bene:

    • Dual diagnosis—a substance abuse diagnosis with a co-occurring mental health diagnosis in the same individual.
    • Substance abuse counselors (e.g. LCDCs, ADCs) do not diagnose mental health disorders. We can only diagnose alcohol/drug addiction problems.

    Resource: Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.
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