Substance Abuse Assessment and Diagnosis

A Comprehensive Guide for Counselors and Helping Professionals

Gerald A. Juhnke

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781135450328
• Edition: 1
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

Substance abuse counseling has gone beyond being viewed as optional training; instead it is fast becoming an essential part of the education of helping professionals. In this book, Dr. Gerald Juhnke presents an innovative, practical model to be used in the assessment and diagnosing of substance abuse and related co-morbid disorders. Substance Abuse Assessment and Diagnosis includes practical "nuts and bolts" direction on how to facilitate a thorough, multi-tiered substance abuse assessment. This book uniquely incorporates detailed examples of how to use individual and significant other clinical interviews, including the CAGE, SUBSTANCE -Q, etc, standardized specialty instruments, drug detection types, and personality instruments to accomplish this feat. This is the only book of its kind that provides practical detail on how to use and score these varied assessment instruments-including the newest "cornerstone instruments, " the MMPI-2, the SASSI-3 and the recently released SASSI-A2.Students and practitioners alike will benefit from this comprehensive volume on the assessment and diagnosis of substance abuse.

Chapter 1
The Clinical Interviews, Standardized Speciality, Drug Detection, and Personality Assessment (CLISD-PA) Model Overview

Chapter 1 Outline:

1. General CLISD-PA Overview
2. CLISD-PA Assumptions
3. Summary

Chapter 1 Learning Objectives:

Upon chapter completion, you should be able to:

• Provide a general description of the CLISD-PA model.
• Identify the purposes of each of the four tiers.
• Report the two basic CLISD-PA assumptions.

General CLISD-PA Overview

The four-tiered Clinical Interviews, Standardized Speciality, Drug Detection, and Personality Assessment (CLISD-PA) model is a progressive, stepwise substance abuse assessment model. The atheoretical model was developed by Juhnke in 1986 as he assessed and counseled alcohol and other drag (AOD) abusing clients and their families. The original CLISD-PA model was refined by the author's clinical experiences. By 1991, Juhnke began using the model as a means of training his master's and doctoral students in the art and science of substance abuse assessment. The current model, then, is founded upon the author's more than 16 years of clinical and clinical supervision experiences. The CLISD-PA model is used by clinical interns and staff supervised by Juhnke in his role as director of the Counseling and Consulting Services Clinic. The clinic is part of the Department of Counseling and Educational Development at the University of North Carolina at Greensboro. All AOD-adjudicated university students are required to participate in substance abuse assessments provided by Juhnke's counselors. Yearly, approximately 200 adjudicated students participate in AOD assessments and counseling services at the clinic under Juhnke's clinical supervision. Additionally, counselors at the clinic provide substance abuse assessment and counseling services to community clients who either have been recently arrested for AOD-related driving charges or are petitioning to reinstate their driving privileges after having their motor vehicle licenses revoked due to AOD-related driving violations.

Tier One of the CLISD-PA model begins with an individual clinical interview (Juhnke, 2000), At the conclusion of the clinical interview, counselors should have sufficient information to determine whether or not a clinical interview with the clients' significant others is warranted.¹ Tier Two is a clinical interview process with the clients' significant others. Persons participating in this clinical interview would typically include partners, close family members (e.g., a parent or sibling), or, depending on the situation, friends deemed supportive and important to the client's treatment. Only clients warranting further specific assessments progress to the third tier. Instruments used here consist of speciality assessments such as the Substance Abuse Subtle Screening Inventory-3 (S ASSI-3). Tier Four includes general personality instruments such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), or the Millon Clinical Multiaxial Inventory-II (MCMI-II). This tiered process (Table 1.1) insures adequate assessment and reduces both traditional testing costs and the time and energy required to administer, score, and interpret such traditional instrument experiences—especially when such testing is unwarranted.

CLISD-PA Assumptions

The CLISD-PA model is founded on two general assumptions. First, multiple information sources provide superior assessments when compared to a single source. In other words, a face-to-face clinical interview with a client may provide valuable treatment information and suffice in providing needed information to accurately diagnose. However, when the face-to-face clinical interview is appropriately coupled with information from outside sources (e.g., partners, spouses, parents, siblings, etc.) or standardized assessment instruments, the assessment is likely to provide a greater context in which to view clients and their presenting symptomatology.

TABLE 1.1. Clinical Interviews Standardized Specialty, Drug Detection, and Personality Assessment (CLISD-PA) Model

Individual Clinical Interview
Sufficient information obtained to develop an accurate DSM–IV–TR diagnosis?
Sufficient information obtained to develop a thorough and effective treatment plan?
Yes: Proceed to significant other clinical interview	No: Identify needed information and continue individual clinical interview
Diagnose and provide therapeutic feedback to client
Significant Other Clinical Interview
Sufficient information obtained to develop an accurate DSM–IV–TR diagnosis?
Sufficient information obtained to develop a thorough and effective treatment plan?
Yes: Proceed to standard alcohol and other drug specialty/drug detection assessment individual clinical interview	No: Identify needed information and continue significant other clinical interview
Review diagnosis and provide therapeutic feedback to client
Standardized Alcohol And Other Drug Specialty/Drug Detection Assessment
Sufficient information obtained to develop an accurate DSM–IV–TR diagnosis?
Sufficient information obtained to develop a thorough and effective treatment plan?
Yes: Proceed to personality assessment	No: Identify needed information and continue standardized alcohol and other drug specialty/drug detection assessment
Review diagnosis and provide therapeutic feedback to client
Personality Assessment
Sufficient information obtained to develop an accurate DSM–IV–TR diagnosis?
Sufficient information obtained to develop a thorough and effective treatment plan?
Yes: Review diagnosis, coestablish treatment plan with client, and initiate treatment	No: Identify other information needed and conjointly determine with client how to obtain it

Many times, clients will inadvertently or intentionally fail to present the full picture of their symptomatology. For example, an alcohol-abusing client may provide sufficient information for the counselor to accurately diagnose alcohol dependence. However, via an additional interview with the client's spouse, for example, the counselor may further learn that the onset of the client's alcohol and cocaine dependence began early in the client's life—as compared to only alcohol dependence portrayed by the client—and that the client was encouraged by legal counsel to seek counseling before his upcoming driving under the influence (DUI) court arraignment. Clearly, such added information gained by an additional interview will be helpful to the counselor providing treatment services to this client.

The second general CLISD-PA model assumption is that, when warranted, progressive "tiers" of intensive assessment are used. Thus, after the individual face-to-face clinical interview with a client, the counselor may perceive that a sufficient clinical picture has been developed to both provide an accurate diagnosis and effective treatment interventions. Hence, no further assessment would be warranted.

However, should the counselor perceive the need for more intensive assessment based on information gathered via the individual clinical interview, or the absence of it, the counselor may deem it important to complete all four assessment tiers. Thus, the counselor completes both individual and significant other clinical interviews, as well as specialty and broad-spectrum personality assessments. For example, within an individual clinical interview a client might present as emaciated, yet deny eating-disorder symptomatology. During Tier Two, the significant other interview, her parents might respond to posed eating disorder questions by stating. "Oh no, Sara is just naturally thin." Despite such claims by client and parents, the counselor may still suspect comorbid marijuana abuse and eating disorder diagnoses. Therefore, the counselor may logically move to the CLISD-PA model's third tier. Here, the counselor will administer additional specialty assessment instruments specific to AOD abuse (e.g., the Adult Substance Use Survey) and eating disorders (e.g., the Eating Disorders Inventory). Should either specialty instrument note the likely presence of one or both disorders, a broad-spectrum personality instrument such as the Millon Clinical Multiaxial Inventory-II (MCMI-II) will be administered to learn more about the client. Simply stated, then, when the counselor's clinical judgment suggests additional levels of assessment are warranted or when the assessments already utilized are incongruent or suspect, more intensive assessment tiers are used.

This second assumption also reminds counselors that all clients do not need each of the four assessment tiers, nor do all clients require the administration of identical assessment instruments. Basically, the CLISD-PA model encourages counselors to match both the levels and types of assessments to the client's specific needs. Stated differently, assessment instruments should form to the individual client's needs, not the other way around. Thus, this second assumption is in direct contrast to counselors and agencies that require all participating clients to complete the same assessment instruments regardless of individual concerns and presenting symptomatology.

Summary

This brief introduction has given readers a succinct history and description of the CLISD-PA model. The next chapter begins with a rudimentary overview of substance-related disorders contained within the Diagnostic and Statistical Manual of Mental Disorders (4th Edition)-Text Revision (2000) (DSM-IV-TR) and progresses through each of the specific CLISD-PA model tiers. Thus, by the conclusion of the book, readers will have a practical understanding of substancerelated disorders necessary for effective client treatment and a thorough understanding of how to use the CLISD-PA model when assessing client AOD.

1. It is important that a release of confidential information be agreed to and signed by clients prior to interviewing their significant others. Speaking to significant others prior to gaining such...