Dimensional Assessment for Co-Occurring Disorders 8th Annual Prevention and Recovery Conference Todd Crawford, LPC, LADC Director, Residential Services Chickasaw Nation Assessment • Is a process • Initial and ongoing components • Comprehensive biopsychosocial with a risk/severity rating • An immediate need profile • Initial and ongoing multidimensional assessment Biopsychosocial Assessment Elements • • • • • • • • History of present episode Family history Developmental history Addictive behavior history Personal/social history Legal history Psychiatric history Medical History (ASAM Criteria, 2013) Biopsychosocial Assessment Elements, Continued • Spiritual history • Review of systems (present and past medical and psychological symptoms) • Mental status examination • Physical examination • Formulation and diagnoses • Survey of assets, vulnerabilities, and supports • Treatment recommendations (ASAM Criteria, 2013) Information Collection • • • • • • • Intake forms Screening tools Assessment tools Structured interviews Collateral information DSM-5 Organization should develop a structured process Multidimensional Assessment • ASAM identifies 6 dimensions 1. Acute intoxication and/or withdrawal potential 2. Biomedical conditions and complications 3. Emotional, behavioral, or cognitive conditions or complications 4. Readiness to change 5. Relapse, continued use, or continued problem potential 6. Recovery/living environment (ASAM Criteria, 2013) ASAM Dimension 1 • Acute intoxication and/or withdrawal potential: Exploring an individual’s past and current experiences of substance use and withdrawal (ASAM Criteria, 2013) Dimension 1 Assessment Considerations • Risk associated with the person’s current level of acute intoxication • Are intoxication management services needed • Is there significant risk of severe withdrawal symptoms • Are there current signs of withdrawal • What are the scores of standardized withdrawal rating scales • What do vital signs indicate • Are there sufficient supports to allow for ambulatory withdrawal management (ASAM Criteria, 2013) ASAM Dimension 2 • Biomedical conditions and complications: Exploring an individual’s health history and current physical condition (ASAM Criteria, 2013) Dimension 2 Assessment Considerations • Are there current physical illnesses, other than withdrawal, that need to be addressed • Are there chronic conditions that need stabilized or ongoing disease management • Is there a communicable disease present that could impact the wellbeing of others • For female individuals, is the person pregnant and what is the pregnancy history (ASAM Criteria, 2013) ASAM Dimension 3 • Emotional, behavioral, or cognitive conditions and complications: Exploring the individual’s thoughts, emotions, and mental health issues (ASAM Criteria, 2013) Dimension 3 Assessment Considerations • Are there current mental health conditions that need to be addressed • Are there chronic conditions that need stabilization or ongoing treatment • Do any mental health symptoms appear to be an expected part of the addictive disorder, or do they appear autonomous • Even if connected, do these symptoms appear severe enough to warrant specific treatment • Is the person able to manage the activities of daily living • Can the person cope with any mental health conditions (ASAM Criteria, 2013) Further Considerations for Dimension 3: Risk Domains • • • • • Dangerousness/Lethality Interference with addiction recovery efforts Social functioning Ability for self care Course of illness (ASAM Criteria, 2013) ASAM Dimension 4 • Readiness to change: Exploring and individual’s readiness and interest in changing (ASAM Criteria, 2013) Dimension 4 Assessment Considerations • How aware is the individual of the relationship between his/her substance use or other behaviors involved in the pathological pursuit of reward or relief and his/her negative life consequences • How ready, willing, and able does the person feel to make changes in his/her substance use or addictive behaviors • How much does the person feel in control of his/her treatment services (ASAM Criteria, 2013) ASAM Dimension 5 • Relapse, continued use, or continued problem potential: Exploring an individual’s unique relationship with relapse or continued use or problems (ASAM Criteria, 2013) Dimension 5 Assessment Considerations • Is there immediate danger of continued severe mental health distress and/or substance use • Is there cognitive capacity to recognize, understand and cope with disorder(s) to prevent relapse, continued use, or problematic behavior (suicide, etc) • Has medication assisted in recovery before • What are current coping skills in dealing with protracted withdrawal, cravings, or impulses • What are current coping skills in dealing with negative effects of peer pressure and stress without reoccurrence of addictive thinking and behavior • Is there knowledge around relapse triggers (ASAM Criteria, 2013) ASAM Dimension 6 • Recovery/living environment: Exploring an individual’s recovery or living situation, and the surrounding people, places, and things (ASAM Criteria, 2013) Dimension 6 Assessment Considerations • Do any family members, significant others, living situations, or school or work situations pose a threat to the person’s safety or engagement in treatment • Are there supportive family, friendships, financial resources, or educational/vocational resources • Are there legal, vocational, regulatory, social service agency, or criminal justice mandates that may enhance motivation for engagement in treatment • Are there transportation, child care, housing, or employment issues that need to be addressed (ASAM Criteria, 2013) Assessment Complexities for COD • Welcoming – individuals with COD are welcomed and encouraged to discuss all issues in treatment to get help with managing mental health and addiction issues. • Access – barriers based on the presence of psychiatric diagnosis or prescribed psychotropic medications are eliminated. Also, barriers based on current substance use are eliminated. (ASAM Criteria, 2013) Assessment Complexities for COD • Screening – routine screening for substance use, other addictive, mental health and trauma issues and the results inform the assessment and intervention processes (ASAM Criteria, 2013) Assessment Complexities for COD • Assessment - further identification of existing substance use, addictive behavior, and mental health conditions (ASAM Criteria, 2013) • Medical necessity criteria and diagnosis • Sorting out substance use, substance intoxication, substance withdrawal, substance induced and or stand alone diagnoses • Acute and chronic (timelines) • Screening and assessment instruments and processes Instruments and/or Processes • • • • • • CIWA-AR, COWS, Fagerstrom, CINA Biopsych-social ASI CAAPE LOCI Constructs for dimension 5 – a) historical pattern of use, b) pharmacological responsivity, c) external stimuli responsivity, and d) cognitive and behavioral measures of strengths and weaknesses Contact Information Todd Crawford, LPC, LADC/MH Director, Residential Services Chickasaw Nation (580) 310-7993 todd.crawford@chickasaw.net