Clinical Clinical Evaluation of Evaluation of

AddictionAddictionDr. Ahmed Albehairy, M.DDr. Ahmed Albehairy, M.D

Psychiatry Consultant Psychiatry Consultant

MOHMOH

Clinical Evaluation Clinical Evaluation VariesVaries

??? Addiction ??? Addiction ApproachesApproaches

Clinical Diagnosis for discussion Clinical Diagnosis for discussion internal medicine/ psychiatry /addictioninternal medicine/ psychiatry /addictionMark degree of importance for each??Mark degree of importance for each??

Provisional. Provisional. Etiological/ pathology.Etiological/ pathology.Disease/syndrome.Disease/syndrome.Symptoms ?? Craving.Symptoms ?? Craving.Psychodynamic mostly CBT.Psychodynamic mostly CBT.Problems/ ComplicationsProblems/ ComplicationsD.D.D.D.Deferred and follow up of change base line.Deferred and follow up of change base line. Needs of the patient.Needs of the patient.

Core principles: Source of Core principles: Source of informationinformationProper Clinical assessment process is important to Proper Clinical assessment process is important to

generate a solidly supported treatment plan.generate a solidly supported treatment plan.

- Clinical judgment.Clinical judgment.

- Patient’s self-report.Patient’s self-report. ( individualize ttt , ttt goals ( individualize ttt , ttt goals are mutually determinedare mutually determined and targeted at real and targeted at real needs, enhance the pt”s motivation).needs, enhance the pt”s motivation).

- Collateral reportsCollateral reports : family , as the pt is nt always : family , as the pt is nt always willing , to know how other perceive the problem, willing , to know how other perceive the problem, and to note whether the pt had trouble with other and to note whether the pt had trouble with other intervention.intervention.

Goals of a Clinical Needs Goals of a Clinical Needs Assessment Assessment

Beside providing the diagnosis for Beside providing the diagnosis for treatment of substance use disorders,treatment of substance use disorders,

Needs assessment process is essential:Needs assessment process is essential:

1)Provide report for multiple service 1)Provide report for multiple service sectors.sectors.

2)Broad ranges of life areas.2)Broad ranges of life areas.3)identify,and response to co-occurring 3)identify,and response to co-occurring

disorders, and environmental or disorders, and environmental or situational risk factors.situational risk factors.

Goals of a Clinical Needs Goals of a Clinical Needs Assessment (cont.)Assessment (cont.)

4)identify, strengths, Psycho-Social-Spiritual supports, 4)identify, strengths, Psycho-Social-Spiritual supports, personal resources and interpersonal resources.personal resources and interpersonal resources.

5)Identify the patient’s involvement with other 5)Identify the patient’s involvement with other systems.systems.

6)Identify possible barriers to treatment.6)Identify possible barriers to treatment.

7)Provide base line for monitoring change in the 7)Provide base line for monitoring change in the problems.problems.

8)Support evidence based practice.8)Support evidence based practice.

9)Good validity and reliability.9)Good validity and reliability.

10)Adminstered and interpreted with cultural 10)Adminstered and interpreted with cultural sensitivity.sensitivity.

Hallmarks of a Good Hallmarks of a Good Clinical Assessment Clinical Assessment

Informs the treatment plan.Informs the treatment plan.

Cross-checks for inconsistencies in Cross-checks for inconsistencies in the patient’s self-reported the patient’s self-reported information.information.

Help facilitate patient recall and Help facilitate patient recall and give the patient voice.give the patient voice.

Using the Assessment for Using the Assessment for Severity-Based Problem Severity-Based Problem

PrioritizationPrioritization Assessing recency, breadth and Assessing recency, breadth and

prevalence of clinical problems.prevalence of clinical problems.

Using scale scores in assessment as Using scale scores in assessment as measures of problem severity.measures of problem severity.

Treatment and problem history as an Treatment and problem history as an indicator of severity.indicator of severity.

Global Appraisal of Global Appraisal of Individual Needs (GAIN)Individual Needs (GAIN)

LECTURE ABBASSIA MARCH2013\ALECTURE ABBASSIA MARCH2013\ABBSIA 2013\GAIN-I Global AppraisalBBSIA 2013\GAIN-I Global Appraisal Individual Individual Needs.pdfNeeds.pdf

Structure of GAIN Structure of GAIN clinical scaleclinical scale

Addiction Severity IndexAddiction Severity Index(severity and baseline (severity and baseline

follow up)follow up) General infoGeneral info Additional tests??Additional tests?? Employment/support status.Employment/support status. Alcohol/drug.Alcohol/drug. Legal status.Legal status. Family history.Family history. Family and social relationship.Family and social relationship. Psychiatric status.Psychiatric status. Severity profile .Severity profile .

Addiction Severity IndexAddiction Severity IndexSeverity Rating for the Interviewer Severity Rating for the Interviewer

Addiction Severity IndexAddiction Severity IndexSeverity Rating for the patientSeverity Rating for the patient

Problem Severity and Intervention Problem Severity and Intervention History GridHistory Grid

CB Approach, case CB Approach, case formulationformulation

Relevant childhood data.Relevant childhood data. Current life problem. Current life problem. Already Already

investigatedinvestigated.. Core beliefs ( Core beliefs ( unlovable or helplessunlovable or helpless).). Conditional assumptions/beliefs/rules Conditional assumptions/beliefs/rules

( ( +ve or –ve).+ve or –ve). Compensatory strategies. (Compensatory strategies. (compulsive, compulsive,

inappropriate, energy depleting, not inappropriate, energy depleting, not balanced, usage of drug.)balanced, usage of drug.)

CB Approach, case CB Approach, case formulation (cont.)formulation (cont.)

Vulnerable situations, Vulnerable situations, cues. Internal – cues. Internal – externalexternal..

Automatic thoughts (Automatic thoughts (core- conditional – core- conditional – drug related).drug related).

EmotionEmotion associated with automatic associated with automatic thoughts .thoughts .

Behaviors ( Behaviors ( drug seeking, irresponsible drug seeking, irresponsible activities, abuse others, avoidance.activities, abuse others, avoidance.

Integration of the above data .Integration of the above data .

Steps of changeSteps of change

MAC2- QuestionnaireMAC2- Questionnaire

Diagnosis and Diagnosis and ClassificationClassification

Comparison of DSM-IV and ICD-10.Comparison of DSM-IV and ICD-10.

Future consideration in Future consideration in diagnosis.DSM-5diagnosis.DSM-5

TREATMENT PLANNINGTREATMENT PLANNING

Acute alcohol or drug intoxication or Acute alcohol or drug intoxication or withdrawel potential.withdrawel potential.

Biomedical condition and Biomedical condition and complications.complications.

Emotional, behavioral, cognitive Emotional, behavioral, cognitive conditions and complications.conditions and complications.

Readiness to change.Readiness to change. Relapse, continued use, and continued Relapse, continued use, and continued

problem potential.problem potential. Recovery environment.Recovery environment.