Substance Abuse Counseling Theory and Practice 5th Edition – Test Bank

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Chapter 5: Assessment and Diagnosis

Objectives

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To provide students with an overview of issues and information related to the

assessment and diagnosis of

substance abuse problems.

To provide a format for completing a diagnostic interview with substance abusers

and/or their significant

others.

To inform students of the current diagnostic criteria used in by the American

Psychiatric Association in the

DSM-IV-TR.

To define behavioral characteristics associated with substance abuse.

To describe common characteristics and behavioral patterns seen in families of

substance abusers.

To acquaint the student with major assessment and diagnostic instruments and to

provide an introduction to

the use of these instruments in a clinical setting.

To review challenges in differential and dual diagnosis.

Key Terms and Definitions

Chronic Phase: Final phase of addiction characterized by loss of behavioral control

and physical manifestations that

accompany chronic drug use, such as continuous use for longer periods, indefinable

fears, impaired judgment and

irrational thinking, physiological problems, and obsessive use.

Crucial Phase: Middle phase of chemical addiction with more pronounced behavioral

changes associated with

addiction, such as loss of control, denial and minimization, confrontation by

others, guilt and remorse, periodic

abstinence, and more frequent use.

Denial: Cognitive process that minimizes the impact of substance abuse and distorts

the reality of the impact of

addiction on both the user and significant others.

Diagnostic Interview: A structured interview format that assists in evaluating the

level of severity of substance use

and formulating an accurate diagnosis.

Differential Diagnosis: The process of determining whether symptoms exhibited by a

client are evidence of a

psychological/behavioral disorder or substance abuse or dependence.

Dual Diagnosis: The co-occurrence of both a psychological disorder and a substance

abuse disorder.

Prodromal Phase: First phase of chemical addiction in which casual or social use of

a substance begins to change

and the first signs of dependence are seen, such as tolerance, blackout,

preoccupation with use, sneaking or hurried

ingestion, or avoiding reference to use.

Substance: According to DSM-IV-TR, a drug of abuse, a medication, or a toxin that

is used in a manner incongruent

with medical treatment.

Substance Abuse: The DSM-IV-TR category that describes a maladaptive pattern of

substance use that is lesssevere than Substance Dependence.

Substance Dependence: The DSM-IV-TR category that describes a maladaptive pattern

of substance use leading to

clinically significant impairment or distress.

27Key Websites

Diagnostic and Statistical Manual (DSM-IV-TR), http://www.PsychiatryOnline.com

National Institute on Alcohol Abuse and Alcoholism, http://www.niaaa.nih.gov

National Institute on Drug Abuse, http://www.nida.nih.gov

Substance Abuse & Mental Health Services Administration, http://www.samhsa.gov

Activities

1.

Have students engage in ―mock interviews with each other using the CAGE ‖

Questionnaire. Discuss how

they obtained information following any ―yes responses. ‖

2.

Have students complete the Substance Abuse History Questionnaire and discuss in

small groups their

reactions when answering the questions.

3.

Have students watch a movie in which substance abuse is depicted and write a brief

report or discuss in class

the reactions that family members or significant others demonstrated in response to

the substance user.

4.

Provide case examples and have students meet in small groups to determine what

assessment instruments they

would use to evaluate substance abuser problems.

5.

Have students engage in role-playing a client who is in denial of a substance abuse

problem. Discuss in class

their reactions to interviewing a client who is resistant.

6.

Have students give examples of quotations that could be associated with each of the

four stages of the family

system of the addict.

7.

Have students list mental health diagnoses that mimic some symptoms of substance

abuse and dependence.

Then have them discuss how to differentiate between these psychiatric disorders and

substance abuse related

problems.

Essay Questions/ Discussion Starters

1.

Describe and discuss some of the factors that complicate the process of the

assessment and diagnosis of

substance abuse.

Answers could include:

Assessment and diagnosis is complicated by denial and minimization on the part of

both the substance

user and family members.



There is no medical or psychological/behavioral measure or test that provides

complete assurance that

a substance abuse disorder is or is not occurring.



Symptoms of substance abuse may also be similar to other behavioral, psychological

and medical

disorders.



Lack of trained medical and mental health professionals who are familiar with the

symptom patterns

associated with substance abuse and dependence

2.

Name and describe the characteristics of two of the four stages in the dynamics of

an addict’s family.

Answers could include:

28The stages in the family are:



Denial: The family denies there is a substance use problem; they hide evidence;

excuses are made; the

family becomes more isolated.



Home Treatment: Family members try to get the addict to stop using; they hide drugs

or alcohol; roles

in the family change; members ignore their own problems or symptoms; they focus on

controlling the

substance abuser.



Chaos: Others outside the family become aware of the problem; conflicts escalate;

family members

experience increasing problems; possibility of abuse or domestic violence; threats

of divorce or

separation; withdrawal of family support.



Control: Family members attempt to take complete control of the substance abuser;

the abuser becomes

marginalized in the family; divorce or separation; cycle of failed attempts to

control.

3.

Describe one of the tests used to assist in the diagnosis of an alcohol or

substance abuse problem. What is the

clinical rationale for its use? With what type of client would you administer this

test?

Answers may include:



Michigan Alcoholism Screening Test (MAST) or Short Michigan Alcoholism Screening

Test (SMAST):

useful with a variety of adult and adolescent populations, easy to administer and

score, wellstandardized, can be given orally or as questionnaire, useful as a

screening tool to determine if further

evaluation is necessary. Used with both adolescent and adult, males and females.



The Drug Abuse Screening Test (DAST-20): self-report inventory designed to measure

drug use other

than alcohol, helps differentiate between categories of drug use, correlates with

other drug use

screening tools and with DSM-IV-TR criteria. Used with both adults and adolescents,

males and

females.



The CAGE Questionnaire: useful with both substance user and family, easy to

administer, can

administer verbally as part of interview, well-standardized with a variety of

populations, can be adapted

to either alcohol or other drugs, used a screening tool to determine need for

further assessment. Used

with both adult and adolescent, alcohol and drug users, males and females.



The Substance Abuse Subtle Screening Inventory-3 (SASSI-3): identifies abuse

patterns that are hidden

by more subtle forms of denial, covers a broad spectrum of substance use, is “non-

threatening”, is

resistant to “faking”, used for both alcohol and other drugs, available for both

adults and adolescents.Used with adults and adolescents, drug and/or alcohol users, males and females.



The Alcohol Use Inventory (AUI): a self-report questionnaire that correlates with

DSM-IV-TR

diagnoses, provides information on a number of different aspects of problems

related to alcohol abuse,

easy to administer. Used with adult, male and female, alcohol users.



The Addiction Severity Index (ASI): assists in treatment planning, easy to

administer, helps determine

the severity of drug/alcohol use, structured interview format, can be adapted to

client’s level of

education, useful training tool for counselors. Used with adult, drug and alcohol

users, males and

females.



Adolescent Diagnostic Interview (ADI): helps to identify and plan for treatment

with adolescents, easy

to administer, administered as part of screening or diagnostic interview, provides

a comprehensive

review of symptoms. Used with adolescents, drug and alcohol users, males and

females.



Millon Clinical Multiaxial Inventory (MCMI-III) and Minnesota Multiphasic

Personality Inventory

(MMPI-2): used in general psychological assessment, help identify clients who may

be trying to “look

good” or minimize problems, can identify problems or personality functioning that

is often associated

with substance abuse. Used with adults, males or females.

29Multiple Choice Questions

1.

The most important part of the assessment procedure for identifying substance abuse

is:

(a) The diagnostic interview

(b) The administration of the MAST

(c) An interview with the client’s physician

(d) A referral for psychological testing

2.

The two primary diagnostic categories related to substance abuse in the DSM-IV-TR

are:

(a) Intoxication and withdrawal

(b) Dependence and addiction

(c) Abuse and dependence

(d) Acute and chronic

3.

Beginning therapists need to be aware of problems that can interfere with diagnosis

such as:

(a) Development of biases about substance abusing clients

(b) Therapists not recognizing comorbid conditions

(c) A client’s attitude and sense of shame may create a barrier

(d) A and C

4.

The primary difference in symptoms between the categories of abuse and dependence

is:

(a) The level of alcohol or drugs in the blood

(b) Severe medical complications due the substance abuse

(c) Blackouts

(d) Increased tolerance and/or withdrawal symptoms

5.

In the area of substance abuse, the term ―tolerance means: ‖

(a) The user likes the effect of the drug more over time

(b) The user’s family and friends become less confrontational as the user becomes

more adamant in his

denial of any problem

(c) There is a need over time to use more of the substance or to use more

frequently to attain the desired

effect

(d) The user system becomes more efficient in metabolizing the substance so less is

needed for the desired

effect

6.

The most powerful factor in complicating the clinician’s ability to make an

accurate diagnosis of a substance

abuse problem with a client is:

(a) Acute intoxication

(b) Denial

(c) Neurological damage(d) Shame

7.

The most researched diagnostic instrument for alcoholism is the self-administered

__________.

(a) Michigan Alcoholism Screening Test (MAST)

(b) Drug Abuse Screening Test (DAST-20)

(c) Addiction Severity Index (ADI)

(d) Millon Clinical Multiaxial Inventory (MCMI-III)

8.

Behavioral symptoms included in the Chronic Phase of substance abuse include all of

the following EXCEPT:

(a) Impaired judgment and irrational thinking

(b) Continuous use of the substance for longer periods

(c) Obsessive use of the substance until recovery or death

(d) The onset of blackouts

309.

In general, a drug or alcohol problem requires treatment if it interferes in the

six major areas of functioning,

including: job or school, family relationships, legal problems, financial problems,

medical problems, and

__________ relationships.

(a) Coworker

(b) Romantic

(c) Social

(d) Professional

10.

Which of the following is one of the questions asked of a client as part of the

administration of the CAGE

Questionnaire?

(a) What is your primary drug of choice?

(b) Do you drink or use significantly more now than you did two months ago?

(c) Do you ever take a morning eye-opener?

(d) Have you lost a job in the past year?

11.

The majority of substance abusers also suffer from the personality disorder of:

(a) Antisocial personality

(b) Narcissistic personality

(c) Dependent personality

(d) None; there is no significant correlation between substance abuse and

personality disorders

12.

In regard to dual diagnosis, there is often a relationship between:

(a) Alcoholism and depression

(b) Cocaine abuse and paranoid personality

(c) Poly-substance abuse and anxiety

(d) Amphetamine use and post-traumatic stress disorder

13.

The most pragmatic definition of substance abuse is:

(a) An addict is anyone who uses more than I do

(b) Addiction exists when drugs or alcohol cause impairment of health and social

functioning

(c) A substance abuser is anyone who experiences a blackout

(d) An addict is someone who must use their substance of choice every day

14.

The first, second and third phases of addiction are labeled as:

(a) Prodromal, crucial, and chronic

(b) Early, middle, and crucial

(c) Primary, dependency, and addiction

(d) Primary, dependency, and chronic

15.

Generally, a/an __________ approach is helpful in clarifying the difference betweenpsychiatric and substance

abusing symptoms.

(a) Integrative

(b) Cognitive

(c) Medical Model

(d) Longitudinal

16.

Early in the assessment process, a standard practice for clinicians working with

substance abusers is to refer

the client for:

(a) A physical

(b) Group counseling

(c) Family therapy

(d) A psychological evaluation

3117.

When concerned about substance, questions family members might ask include:

(a) Does the user’s personality change while using?

(b) Has anyone been concerned or embarrassed about the use?

(c) Have you or others been uncomfortable about your safety in circumstances such

as riding in a car when

the user has been driving after having a drink?

(d) All of the above

18.

What can be compared with the responses given by the client in order to assess the

degree of minimization or

denial that may be present?

(a) Previous behaviors

(b) Information gathered from the client on an earlier survey

(c) Information gathered from others

(d) None of the above. It is not possible to assess the degree of minimization or

denial that may be present.

19.

As the user continues to become more heavily involved in abuse or dependence on a

drug, the primary

relationship in life eventually becomes the relationship with _______________.

(a) The supplier

(b) The substance

(c) Another user

(d) All of the above

20.

The act of determining the nature and causes of a client’s problem is known as

_______________.

(a) Assessment

(b) Diagnosis

(c) Treatment

(d) Analysis