Assessment Review for the Addiction Counselor Exam

Welcome to the Addiction Counselor Exam
Review. This presentation is part of the Addiction Counselor certification
training. Go to to learn more about
our specialty certificates starting at 149 dollars. Hi everybody and welcome to the
assessment review for the Addiction Counselor certification exam. We’re going
to be talking about, guess what, assessment. And a lot of this is geared
to be basically just a primer a review a Cliff’s Notes version if you are feeling
weak on the assessment process it is really important that you go back and
you review assessment courses either that you’ve taken or you can review some
of the assessment courses that are in our addiction counselor certification
training tract so there are twelve steps to assessment engage you know as soon as
you meet somebody you’re not gonna have rapport so you’ve got to develop rapport
don’t sit them down and say you know hey I’m you know dr. so-and-so and you know
nice to meet you John Smith let’s go where do you live and start filling out
forms right away take time to get to know them look them in the eye talk to
them for a minute it doesn’t have to be a huge
conversation for an hour but is when people feel like numbers they’re not
going to engage so you want them to feel like you really care about them as a
person get authorizations and gather information from collateral sources
probation officers family members what wherever you think you can get
collateral information another good source is from other treatment providers
that are either currently working or have worked with the client in the past
screen for co-occurring disorders determine the severity of mental and
substance use disorders so you may have somebody who has a moderate alcohol
dependence issue but they have got really significant clinical depression
so you know you’re going to be dealing with those differently obviously we need
to make sure that we help them get stabilized and you want to make the
appropriate placement recommendation based on the client’s needs determine
the appropriate level of care generally we use the ACM to do this sometimes you
use the locus which is another patient placement guide that can help you
determine where a client is is best served determine their diagnosis and
generally there’s more than one so you want to look for mental health issues
you want to look for substance issues you want to look for poly substance
issues you want to look for issues that may not be in the DSM you know you’re
looking for other psychosocial issues that may be contributing to the problem
like domestic violence or lack of housing determine disability and
functional impairment so how bad is this on a scale of you know one two not
really bad I could see you once a week outpatient and not a problem
to five the patient needs to be in 24-hour medically monitored residential
care in the hospital you know you’ve got and the ACN breaks it up really nice for
you you’re going to determine where they need to be how much is it impacting
their ability to work their ability to do activities of daily living their
ability to form fulfilling relationships their ability to have a rich and
meaningful life and that’s what we mean by disability and functional impairment
how much is it impairing them keeping them from reaching their full abilities
and having a rich and meaningful life identify their strengths and supports
because we’re going to build off of these what have they done up until now
to survive what things work for them when they’re feeling depressed when
they’re wanting to use identify cultural and linguistic needs and supports so you
know if they’re talk with them about their culture and whether they want to
involve any faith healers or if there are any cultural practices that they
think are important to their recovery process if you need an interpreter
obviously you’re going to take care of that now and be careful about jargon
that you use try not to use any and colloquialisms or local phrases that you
may use that they may interpret differently so
be sensitive to a person’s culture and background and meet those needs as
needed identify additional problem areas such as medical housing and education
determine their readiness for change for each problem and I’ve said it before
I’ll say it again and I’ll probably say it many times after this people may have
an addiction issue they may have a depression issue they may have a PTSD
issue and a diabetes issue okay so they’ve got four different issues going
on with their depression they may be really ready to make that go away
because they are tired of being depressed and there is really no not
much of an upside to being depressed it’s painful so they’re ready to work on
that the addiction they may not be able to envision themselves as being a
non-drinker never drinking again are never using again or they may not be
ready to give that up because smoking a joint is the only thing that helps them
relax right now so they may not be motivated to change that problem or make
huge changes in that problem so you need to determine their readiness for change
for each identified problem area and then start to plan treatment this is
when you figure out okay where are they gonna go and what kinds of services are
they going to need and what do I need to link them to so screening determines the
possible presence of an issue assessment is a much more in-depth interview and
it’s an ongoing process it’s not something that you do for an hour at the
beginning and then you never do again you’re going to assess clients every
time they come into your office you’re going to assess clients a lot the first
three or four times you see them because they’re not going to think to tell you
everything in the intake and you’re not going to think to ask about everything
you’re going to learn more about them and as you learn more about them it may
change their treatment plan a little bit assessment determines the nature and
severity of the problems develop specific treatment
recommendations and surveys clients strengths and resources for addressing
life issues so when we’re talking about strengths and resources we’re talking
about what do you have going for you you know let’s look at social support do
you have people who can help you out people who you can lean on financial
support what kinds of financial resources do you have for child care or
treatment or maybe taking some time off from work you know we’re looking not
only as strengths the way they’ve coped with these problems before and you know
things they have inside them that can help them succeed at being happy and
healthy but we’re also looking at what resources they have personally as well
as what resources can they tap into you know maybe they don’t have enough money
to hire a nanny to come in to help them with their three children but maybe
their church offers drop-in childcare or maybe there’s a church that they don’t
even belong to that is willing to let them drop their kids off at the church’s
drop-in childcare so we want to identify not only what resources the client
personally has but what resources are in the community that the client can access
to help them address their life domains or issues in their different life
domains the a lot of law schools offer free clinics so if the client has issues
with child custody or a divorce or bankruptcy or any kind of stuff like
that they may be able to get pro bono help at a free Law Clinic some attorneys
do pro bono work so can contact your local Bar Association and find out if
there are attorneys in your area that can help your client so this is the way
you find out things contact local boards to find out you know local dental boards
to find out if there are any free dental clinics contact the United Way
information and referral they know about a lot of programs that are out there
that can help people get medications eyeglasses child care housing assistance
paying for electric bills you know is limitless so United Way
two-one-one is a great great resource the substance abuse assessment focuses
on historical and situational factors contributing to or triggering use
now remember substance abuse doesn’t necessarily just have to be drugs we can
be talking about things like gambling addiction sex addiction yes you know
they’re not all in the DSM but we do want to look at those addictive
behaviors because addictive behaviors can cause changes in brain chemistry can
cause that dopamine rush that throws the neuro chemicals out of whack similar to
what some drugs do so it’s important to recognize any behavioral addictive
addictive behaviors as well as chemical ones look at their patterns of use have
they used do they use consistently are they a binge user do they use when
they’re stressed has their use increased over the past five years no showing that
they’re developing a tolerance have they started combining substances or
combining a substance with an activity in order to get that rush that they’re
looking for identify common signs and symptoms of use you’re going to be
administering the cage screening or the audit you also may be looking for you
know your basic checklist have you engaged in the behavior for longer than
intended have you spent more money on this than intended have you spent more
time engaging in recovering from or planning to use then intended have you
given up important psychosocial activities in order to use you know that
whole list of things that indicates that the person has a substance use disorder
and we’re going to talk about the consequences of use you know because
you’ve used how has it impacted you emotionally physically spiritually
socially cognitively occupationally and legally you know
let’s look at those seven areas at least it examines the context in which the
disorders manifest so somebody maybe may not be using all the time or may not be
depressed all the time so what are the contexts in which this gets worse it
explores the reciprocal interactions of family and/or marital life on the
problem social support and interpersonal functioning on the problem their
physical health needs if somebody’s got fibromyalgia for example then when
they’re fibro is acting up and they’re in a lot of pain their addiction or
their depression may also get worse in order to as a result of the fibromyalgia
so we want to look at the physical health needs include in their adequate
sleep and proper nutrition spirituality how does that impact their disorder does
it give them hope or does it make them feel ashamed employment financial issues
and legal issues and any other issues which may impact treatment how do they
impact this disorder and there are the clients ability and willingness to
participate in treatment we also want to look at gender cultural
and linguistic issues some cultures are not comfortable with group treatment
some cultures feel the family should be intimately involved in treatment other
cultures not so much some sometimes gender specific programs are more
helpful inappropriate than mixed programs so you want to talk about you
know how would you feel if you were in a group that had men and women in it look
at their readiness for change and how that impacts their willingness to
participate in treatment their relapse risk again for every single problem
issue not just substances but their relapse risk for depression their
relapse risk for fibromyalgia or you know any physical issues recovery
support who out there can they rely on that provides good support for them in
recovery when they are not actually in treatment any special life circumstances
that may impact their ability to participate in treatment such as being a
single parent single parents not only often have a hard time affording
additional child care but child care can flake out sometimes single parents can’t
afford to take time off from work because there’s nobody else bringing in
money so they’ve got to work so we want to talk about any barriers or obstacles
to full participation and engagement in treatment and also look at medical
conditions if they’ve got it some sort of medical condition that makes it
difficult for them to sit for long periods of time or they’re having
insomnia you know sleep apnea is one that can really is that somebody’s
energy and make it more difficult for them to participate in treatment so once
you’ve looked at all the reciprocal interactions and you’ve tried to figure
out and identify any potential barriers and how to overcome them you’ve
identified all the strengths the client is bringing to the table that you’ve got
to work with and you’ve identified any resources that the client has or that
are in the community that can used to deal with these barriers and
enhance treatment engagement menya moved on move on to providing treatment or
what we’ll talk now about providing treatment based on the client’s
perception of his problems and this is going to coincide with motivation if a
client doesn’t feel that their substance use is really all that bad they may not
be ready to work on it yet so what’s the clients perception of how bad this
problem is what goals does the client wish to accomplish and what strengths
does the client think he or she has so we’re gonna start talking about these
and I’m gonna say what is it that you want to accomplish in treatment and a
lot of times our goals can be similar they may not be the same you know when I
work with clients who are involuntary they may not be wanting to give up
smoking marijuana for example but they want to get off probation I’d love to
see them quit smoking marijuana but I also want to see them get off probation
in order to get off probation they have to quit smoking marijuana so hey I will
help them reach their goal of getting off probation which my goal gets
accomplished in the process and all the better but if you encourage clients to
work towards goals that are meaningful to them they will be more motivated and
engaged so the forms that we’re going to use you want to get collateral
information you want to talk with the client you want to use standardized
interviewers or standardized interviews in some cases standardized interviews
limit the interviewer to a script it requires limited training and it
collects the same information on all clients you know it’s it’s kind of like
when you go to the doctor’s office and they start asking you about different
health conditions you’ve had they’re just checking boxes structured
interviews allow you to ask probing questions and require some additional
training or knowledge to know what follow-up questions to ask so if you ask
a client whether they’ve ever been exposed to a traumatic event and they
say yes you have to know what the appropriate next quest
Chinn is that can probe you know what tell me a little bit about the nature of
that traumatic incident the other thing that you can use and that can be really
helpful our self administer tests and questionnaires they require some
motivation and reading on the clients part but they are nice because the
client can do them at home before they come in and clients tend to be more open
on self administered tests when they’re checking things off as opposed to
looking you in the eye and telling you something that they may find more
embarrassing or shameful or they may think that you’re gonna judge them for
what they did or what they think or whatever so self administer tests can be
really helpful additions to the clinical picture standardized instruments when
you’re using them have reliability that means if you are using an instrument
that says it measures depression we know it actually measures depression
depressive symptoms and when well that’s validity sorry it validly measures it
and then reliability means if you give somebody that assessment today and you
give that somebody somebody that assessment tomorrow it’s gonna give you
some we’re similar in the results it may not be exactly the same because 24 hours
have passed but it’s gonna be really daggone close if it’s not exactly the
same that’s called test retest reliability
and you want to make sure that standardized instruments you’re using do
have test retest reliability and what’s called inter-rater reliability so if I’m
gonna give an assessment to John Cena I come up with these answers and this
scoring and this clinical picture and my friend Sally who works you know two
offices down administers the same instrument to John Smith she should get
a very similar clinical picture if not the same as I did that’s called
inter-rater reliability so we both see the same thing when we administer this
test that would be like an example that comes up a lot is when you observe
clients in natural settings so we’ll use kids for
an example here poor inter-rater reliability would be to identify how
many times Jonny acts out that’s not really well-defined so how I define
acting out may be very different than how Sally defines acting out so I may
end up with seventeen hash marks and she may end up with three that’s very poor
inter-rater reliability because we saw two different things because we were
defining things differently so test retest if you give it the client the
same test within a very short period of time it should give you the same result
and inter-rater reliability if two people are administering the test it
should give the similar result to both people sources of information with
written consent of course personal reports reports from family reports from
other professionals or prior treatment experiences their employment history
criminal records and any available drug tests collateral information gathered
should be confirmed to the extent possible to make sure it’s actually
valid an accurate assessment requires the coherent integration of multiple
sources of information to avoid over or under estimation of the problem and when
you’re hearing it only from the client it’s hard to get a real picture on is it
as bad as the client is saying or is it is not bad a lot of times clients
especially with substance abuse clients will minimize their problems and
minimize the issue so it sounds like there’s no problem and then when we hear
from collateral sources we realized that they were grossly under estimating that
the extent to the problem so you want to get information when I have clients come
in for an assessment for a probation and parole I always have them bring their
criminal history and if they don’t bring it then we look it up before we get
started because I want to see not only how many times they’ve been convicted of
drug charges but also how many times they have been arrested for drug charges
because that gives me a little bit more to go on when
I’m looking to identify whether they’ve they’re experiencing quote repeated
problems in one or more life areas as a result of the addictive behavior drug
testing drug testing is part of the initial assessment and substance use
disorder treatment we want to get a baseline to figure out what you’re using
how much is in your in your system it’s used to identify drugs to make the most
appropriate treatment recommendations alcohol and benzodiazepine withdrawal
can be life-threatening so if I have somebody who test positive for either
one of those I’m obviously gonna make a referral to either a medical doctor who
may want to do ambulatory detox or a detox unit but I am NOT gonna say well
you need to dry out first and just send them on their merry way
likewise there may be certain drugs that people are on that they cannot be
admitted to a treatment center for the treatment center I used to work at we
didn’t admit anyone who was on benzodiazepines so if they were on them
and they were not willing to detox from them or it was clinically
contraindicated then we had to refer them somewhere else you want to use drug
testing to screen to prevent adverse effects of prescribed medications you
don’t want to be taking something that increases serotonin levels and then also
taking an SSRI and then you’ll like a stimulant and an SSRI because you could
precipitate a serotonin crisis so we want to know what’s in there we don’t
want somebody taking prescription benzodiazepines you know prescribed by a
physician while they’re also abusing opiates because those are both
depressants and they could lead to respiratory failure so we need to know
what’s in the person’s system it’s a component of the treatment plan drug
testing helps keep people doing the next right thing if they know that they could
be drug tested at any time it’s a way to monitor the use of substances and
compliance with medications now obviously your on-site drug tests are
not going to tell you the levels of Zoloft are in somebody’s
system or whatever but if you send it off to the lab then you’ll get a mass
spec report back and you’ll be able to tell whether they’re psychotropic
medications or any other medications that they’re on for that matter are
staying stable or if they’re wonky and you’ll also be able to see if levels of
certain drugs are declining for example marijuana takes a long time to go out of
the system so a lot of times people are admitted to
treatment when they still test positive for marijuana and what we want to see is
that THC level declining over a period of a couple of weeks drug testing is a
method to assess the effectiveness of treatment if they’re able to stay clean
and and not test positive then we’re doing something to help them stay clean
I mean something is working here and it’s a method to document abstinence for
legal matters disability issues or custody issues you know any of the legal
stuff drug testing cannot replace an assessment to diagnose a substance use
disorder though we need to look and see what consequences the substance use is
having we need to make sure they meet the criteria for the DSM diagnosis of
substance use disorder and just having a drug in your system doesn’t make you
meet that criteria drug testing can accurately reveal drugs
in the system so if a client says oh I never use that and drug test says they
did you know mass spectrometry is not you know there’s a very very very very
small margin of error yes you can retest it but I’ve never had a mass spec report
turn up wrong or incorrect in 20 years time frame for detection is limited
though so for some substances it’s 24 hours for other substances it’s three
days but you need to get that in there which is why random testing is so
important it is dependable for identifying frequent users but less
accurate for infrequent or binge users so if Tom
as an alcoholic and he binge uses you know one weekend every five or six weeks
the only time you’re gonna test he’s going to test positive is after one of
those weekends and if you’re seeing it for 12 weeks that means you only have
two windows of opportunity there another method for testing that is out there and
available are sweat patches and they stay on the arm for 14 days they are
relatively unable to be adulterated so people can’t you know scam the system so
to speak and they give you a picture of the person’s levels of different drugs
over a longer period of time they can sometimes get what’s the word I’m
looking for corrupted you know if something gets on them that makes it an
invalid test but you have much less ability of for the client to just
eliminate a particular drug so it doesn’t show cocaine or something like
they can try to do in some of the urine screens breathalyzers are usually only
valid for a couple of hours once the substance is out of your system once
your bodies metabolize that breathalyzer ain’t gonna work
urine may be helpful for up to a month depending on the drug you can do on-site
which are your cups now a lot of on-site tests have okay accuracy rates they have
about a thirty percent depending on the company you go with and how well your
people administer the tests about a thirty percent failure rate which means
it can either be a false positive so it turns shows that there’s something in
their system when there really isn’t or a false negative which the drug test
doesn’t show anything being in their system when there really is so you you
have to remember that they’re only about 6570 percent accurate but it’s a good
starting place and the drug cups usually only run between 450 and 8 bucks a pop
we’re sending it to the lab runs anywhere from forty five to eighty
dollars or more depending on how many different
panels you have run so if you have a client and you administer on-site drug
tests that gives you a general idea about how they’re doing and if there’s a
question about it you can send it to the lab and then it’s recommended that like
every third or fourth screen you send to the lab anyway just to make sure that
it’s not showing a false negative gas chromatograph can also be used in order
to identify specifically what’s in the urine saliva will identify what the
person is used with in the past day sweat and hair can be used drug patterns
it shows drug patterns over time especially hair as the hair grows out
you know it will show give a better idea of what was used during time because our
hair grows really slowly so you can get quite a bit of information from a strand
of hair it can’t discriminate from recent and past drug drug use though so
you know we don’t have a way of saying this person used yesterday versus a
month ago because the hair grows really slow and it’s not able to identify use
within the past three to eight days now that’s true for hair for sweat you know
they like to leave the patch on for a full 14 days so you know your accuracy
is a little lower if you pull it off sooner but it does give you a 14 day
snapshot of what’s going on with the person and then blood can be used and
withdrawn if the substance is still in the person’s system then it can show up
in blood another thing you need to do during assessment is a risk assessment
one of the most important functions of both screening and assessment is to
identify any risks for relapse acute medical conditions
you know if they look like they’re getting ready to stroke out or it’s they
start slurring their words they’re detoxing from alcohol it may mean that
they need to have Bioman and in order to prevent brain
damage so we want to look for anything that may indicate a medical or
psychiatric crisis that requires an immediate referral to detox CSU which is
the crisis stabilization unit or the emergency room we want to assess for
intoxication substance toxicity sometimes people will overdose you know
and we want to make sure we identify that I’ve had clients used before
because they wanted to get into detox and in order to get into detox they had
to be under the influence and they accidentally used too much so we want to
look for substance toxicity withdrawal aggression or danger to others potential
for self-harm or suicide and any coexisting mental health issues
especially you know when we’re talking about risk being aware of any psychotic
features hallucinations delusions lack of ability to cognitively put things
together like you would expect signs of drug toxicity or intoxication you know
we’ve gone over that in other reviews especially in the diagnosis review we’re
going to hit it a little bit right here nausea vomiting diarrhea agitation
lethargy or stupor increased or decreased heart rate lack of
coordination and slurring words now remember some of these can also be signs
of life-threatening conditions so you want to be aware and and get medical
input if people are slurring their words or have lack of coordination especially
signs of violence if they have a history of previous violence and mental illness
is not a good predictor of violent behavior so you know don’t just think
that because they have a mental illness they’re going to be by now
what we want to look at is previous violent behavior if they’ve done it
before they’re more more likely to do it again how old they were at the first
incident of violence if they started being violent when they were eight and
they’ve been having problems ever since then more and more likely that they’re
going to have another episode now then if their first violent episode was
when they were 27 and they’re 30 now relationship instability employment
problems substance use problems a lot of substances are disinhibitor x’ so it
takes off that filter that says this is a bad idea
or they’re stimulants which just get the person revved up and angry or anxious
and kind of ready to go get them a major mental illness can be a sign of violence
now a lot of times the site of violence that someone with mental illness does
commit is towards themselves suicide self-injury so just because somebody has
a mental illness again less than four percent of violent acts in the United
States are committed by people with mental illnesses so we want to remember
that personality traits that deviate from social norms if they tend to
exploit people or manipulate them we’re going to be looking for your antisocial
personality disorder traits here early maladjustment or trauma paranoia and
failure to respond to treatment in the past can all be indicators that there’s
a potential for this client to be violent suicidality alcoholism is a
factor in 30% of suicides so if you’ve got a client who abuses alcohol know
that they’re at increased risk ninety percent of people who die by suicide
have a mental health disorder sixty percent of people who die by suicide
have depression so again a lot of the violence in people with mental health
issues is self directed they’re trying they’re making the pain stop they don’t
feel like they can do it anymore they feel hopeless and helpless that life is
gonna get any better three domains for assessment for suicidality current
presentation of suicidality their history and risk management so current
presentation are they tying up loose ends are they willing to talk about and
make future plans if they are that’s a good sign
it’s doesn’t mean you’re in the clear but
it’s a good sign do they have access do they have a plan do they have access to
the means what might trigger them to actually commit suicide you know what
things might happen these are all questions that you want to ask and there
are it’s important that you take a couple of really good classes on suicide
assessment because it is art not a science if they have a history of
suicide attempts or self injurious behavior or a family history of suicide
they’re at higher risk and then as far as risk management you know somebody who
lives alone and is clinically depressed and having suicidal thoughts is at much
greater risk than someone who lives with their spouse and three kids and also has
suicidal ideation now that doesn’t again doesn’t mean
you’re in the clear I know of situations where a parent has gone upstairs and
committed suicide with their spouse and the children in the house so you can’t
assume that just because any one or three or five conditions are present
that the person is out of the woods you know you want to use due diligence signs
of suicidality includes suicidal or self harming thoughts plans behaviors or
intent a specific method identified evidence of hopelessness impulsiveness
panic attacks or anxiety a lack of and or unwillingness to make future plans
signs of tying up loose ends alcohol or other substance use
especially or depressants like opiates and benzos but any substance thoughts
plans or intentions of violence towards others and any current psychiatric
illnesses which again may make them at higher risk for suicide previous
attempts or aborted attempts at suicide or self-harm is also another risk factor
as is a family history of suicide attempts
suicide mental illness and addiction if there’s a family history of mental
illness and addiction it indicates that the family unit may not have the skills
and tools to cope so you know the parents couldn’t teach it to the
children then the children because they didn’t have it then the children may not
have skills and tools to cope so they may be at higher risk
acute psychosocial crises including financial changes or changes in status
so if somebody gets fired demoted passed over for a promotion or you know
something happens and have to declare bankruptcy or whatever this could be a
risk chronic psychosocial stressors including actual or perceived
interpersonal losses so fears of abandonment for example family discord
domestic violence current or past sexual or physical abuse and the absence of
external supports so these are all things we’re going to look for in a
suicide assessment and as we’re going through each of these things you know
when I identify if they have a specific method identified and they had the means
available you know I’m going to talk about how can what can you do with those
means to make yourself safer we’re gonna make a plan we’re gonna make future
plans for when they’re gonna call me when they’re going to contact me we’re
going to talk about how they can avoid using substances we’re going to talk
about what external supports they may be able to rely on in order to help get
them through each hour and we’re gonna talk about you know if they’re having
financial a financial crisis we’re gonna talk about that a little bit and
identify steps that they can take to start resolving this crisis so they have
some hope they have some tools and they have some actions that they may be able
to engage in which are going to obviously happen in the future which may
get them a little bit past this crisis point borderline personality disorder is
something that is common and co-occurring disorders a lot of
times when I’m working with clients with addictions I refer to borderline
personality characteristics because once they get clean and sober a lot of times
those characteristics kind of go away not always but do be aware of a
pervasive pattern of instability in personal relationships self-image and
mood in addition to impulsive ‘ti people with borderline personality disorder
they either love you or hate you and they will turn on a dime so you’re
constantly walking on eggshells to keep from setting them off and to stay on
their good side because they’re there’s no gray area there’s no it really hurt
my feelings that you did XYZ it’s I hate you or I love you there there’s no
middle ground and it’s exhausting for both the person with BPD
characteristics as well as their significant others another common issue
is antisocial personality disorder and again the characteristics of APD are
often present in people in active addiction but they dissipate or
completely disappear once the person is in recovery so both I want to see some
recovery time I personally want to see some recovery time before I assign a
personality disorder diagnosis but what you’re looking for with person
antisocial is a pervasive disregard for and violation of the rights of others
inability to form meaningful relationships and lack of empathy
so think about somebody who’s addicted you know whatever’s gone on they’re at
the point where they’re at bottom well you know they’ve probably been doing
whatever they needed to do to get their drug in order to survive so they’ve been
disregarding the rights of others they’ve not wanted to form meaningful
relationships because they hate themselves they feel bad about what’s
going on with them and they don’t trust other people because they feel like
they’ve been let down and abandoned and they may not have empathy because they
don’t have any energy left to be empathetic with other people it’s
just they’ve tried to be empathetic and they’ve they’ve been burned too many
times and they’re sort of cynical at this point so if you look at it in terms
of what is causing these particular characteristics and how did this person
come to feel or act this way a lot of times you can see where the
situation’s their life over the past five or ten or twenty years it really
makes sense that they’re acting or behaving or thinking or feeling this way
it doesn’t necessarily mean that is a personality disorder that’s going to
stay major depressive disorder is very common when people whose they have
Rush’s of dopamine and to avoid getting into pharmacology we’re just going to
stop short and say when the neurotransmitters are out of whack
because that dopamine system has been in overdrive
then when they don’t have something causing that dopamine to be dumped
people may feel clinically depressed and it can last for quite awhile and this
can go on for over two weeks especially with people who have been abusing
stimulants but it can go in in other people also when people start to sober
up they may look back over you know the chaos that their life has become and get
clinically depressed so do assess for clinical depression you’ll see changes
in sleep appetite energy concentration excessive feelings of worthlessness and
guilt a sense of apathy you know just nothing does it for them they don’t
really care and there may be suicidal ideation also look for bipolar disorder
not uncommon with people with bipolar disorder not wanting to take the bipolar
meds because it flattens the highs it brings up the lows so they’re not having
that major depression anymore but they’re not getting the the highs from
the mania so a lot of times they may be non-compliant with prescribed meds and
then they self-medicate with elicit drugs so as they sober up start
paying attention and looking to see if there are signs of bipolar one or two
anxiety disorders are very common remember the teeter-totter philosophy
with detox whatever drug the person was using and the effects it had when they
detox the likely symptoms are going to be the exact opposite so if they were
using anti-anxiety meds that they were abusing benzodiazepines when they start
to sober up they may have a lot of panic the same thing with alcohol alcohol does
have some depressant effects but when people start to sober up they often have
a lot of anxiety that goes with it so assess for panic attacks panic disorders
and obsessive-compulsive disorder other things to look for a lot of people more
than 50% of the United States population has been exposed to trauma
now just because you’re exposed to trauma doesn’t mean you develop PTSD but
it is important to assess for it because the symptoms of PTSD overlap with
depression and anxiety quite a bit so we want to make sure that we don’t miss
diagnose something and fail to treat PTSD when it really is they’re also
assessed for eating disorders there’s a strong correlation between alcoholism
and bulimia but we want to look for anorexia bulimia bulimia and binge
eating disorder in clients and schizophrenia and psychotic disorders
psychotic OSIS is the term for a severely incapacitated mental and
emotional state involving thinking perception and emotional control
characterized mainly by your hallucinations you think you see hear
smell taste things that aren’t there or delusions false beliefs and a
deterioration and thinking judgment and self control you can have some people
have delusions of grandeur where they think they are head of the CIA or they
think they are God other people will have paranoid delusions that the
squirrels are after the and trying to read their minds so if you
hear things that don’t seem to make sense in your reality start probing for
psychotic features now not everybody who has psychotic features is schizophrenic
you can have psychotic features with postpartum depression with depression
but it’s important to recognize if you see psychotic features and probe to
figure out exactly what’s going on schizophrenia is the most common
psychotic disorder not multiple personalities schizophrenia is a
detachment from reality people who are schizophrenic will talk about the people
on the news media talking directly to them they will say things that don’t
seem to make sense in your world multiple personality is completely
different that’s when somebody has two different or multiple different
personalities in their head they are still in touch with reality you know as
we understand it but you are sort of meeting different people depending on
the situation so don’t confuse the two people do and it’s one of my pet peeves
symptoms of schizophrenia often begin to develop before this first psychotic
episode the persons will start having hallucinations or delusions also
Parkinson’s disease people sometimes have hallucinations and delusions
so rule out some of the physiological causes – they may have disorganized
speech where their speech doesn’t make any sense at all
disorganized or catatonic behavior and deficits and functioning such as you
know getting up in the morning and getting themself ready and typical
activities of daily living so assessment is an in-depth process that involves
information from the client and collateral sources to determine the
nature course and severity of all the issues the mental health issues the
physical issues and the substance abuse issues assessment is a biopsychosocial
in nature so we want to look at what are all the possible causes or contributing
factors to this issue that we may need to address in treatment
you know housing peope need safe housing they need access to
medical care they need to be able to afford their medications they need good
nutrition they need financial independence of some sort
so you know they know where their next meal is coming from
they need a decent self-esteem they need social supports people other people that
provide them love and comfort and attachment and the safety net they may
need childcare legal help you know there’s a whole bunch of stuff that
people may need and all of those things or lack of all of those things can
increase stress and precipitator relapse or perpetuate the problem assessment
must take into consideration cultural factors regarding having multiple
illness the participants in the treatment process and who the
decision-makers are for the client so some cultures will want to have the
family unit in the assessment and obviously if that’s okay with the client
then that needs to be okay with us some cultures are not that way some cultures
have a specific decision-maker for care for anybody in the family usually it’s
the father other cultures people decide their own treatment course it’s
important to evaluate from multiple co-occurring disorders which may have
overlapping symptoms such as PTSD and anxiety or substance abuse and/or
substance use disorder and borderline personality disorder
the assessment will guide placement and the development of the treatment plan

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