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Information about assessment
Assessment of dual disorders is important in order to establish proper treatment systems. Accordingly, specific assessment tools are applied towards certain settings and interventions. This takes into consideration the fact that the combination of dual disorders is different among patients. In relation to both AOD disorders and psychiatric conditions, the process of assessment should be sensitive towards psychological, social and biological issues. All treatment contacts with patients should also include basic screening tests for AOD use and psychiatric disorders. This is regardless of the intervention or treatment setting or the form of crisis that initiated the treatment contact.
The complete assessment of patients who have dual disorders should be managed and performed by clinicians. These clinicians should have certified training in the field they carry out the assessment. However, there are clinicians who are uncertified but can learn how to perform the screening tests. The assessment structure incorporates various procedures in order to ensure maximum results. The assessment should also include a brief mental status exam. This is undertaken in order to assess the severity and presence of psychiatric problems. In addition, it integrates the screening of AOD use related disorders.
Assessment is undertaken under various stages. The stages can be classified in to three clinical phases as long-term, acute and sub acute. Acute and sub-acute are not applied to all conditions. The first stage of assessment incorporates the dangers of the patient towards self and others. It is crucial for patients to be tested on their potential of posing a threat to themselves and others. This process of evaluation is useful in the determination whether there is duty to protect the patients from self-harm and interrupt the intention of violence toward other people. This includes suicidal feelings. The screening personnel should therefore assess whether the suicidal feelings reflect the chronic condition or are transitory.
The assessment process includes the medical and social assessment. The disorder must undertake medical evaluations. This includes a physical examination and a laboratory assessment. Facilities that do not posses a medical component must train the assessment staff on referral and triage. The patients also undergo initial addiction treatments. The CAGE questions are used under this program for screening of patients. CAGE questionnaires modified for other drugs (CAGEAID) are used because they are acute and rapid screening tools for assessing AOD disorders. The “ABC” model is another screening technique towards establishing psychiatric disorders. The drugs under study in dual disorders are similar to those used in society such as cocaine, marijuana and alcohol.
All frontline Initial assessment staff should have proper detailed training in using AOD screening tests and mental status exams. AOD abuse assessment should primarily focus on the recent use of alcohol or other drugs and their behavioral history. The assessment staff should also screen past treatments, hallucinations, previous episodes of delirium tremens and disruptive behavior. The procedure of social assessment is also important for the process. The social environment and conditions are analyzed. This is particularly related to psychiatric and AOD disorders (Ries, 2001). The aspects studied include the living conditions, social relations such as family and friends and the overall support structure.
The long term and sub-acute assessment is undertaken in various settings such as medical clinics, hospitals, mental health clinics, emergency rooms, psychotherapists’ offices, welfare and social services settings and other non-treatment settings. This level involves patients with dual disorders that are not relatively dangerous. They are therefore, candidates for treatment. The functional levels, strengths and liabilities should be assessed. The aim of sub-acute treatment is to develop a plan that has a reduced need to focus on acute protection. The planning is also based on full assessment of the treatment needs.
Patients also undergo medical assessment under this stage. The plan should treat and asses the medical conditions that can complicate or precipitate the dual conditions. These can include other neurological disorders like multiple sclerosis, thyroid problems and HIV infection. Patient’s history of AOD abuse, treatments and problems are also analyzed. The assessment staff also carries out addiction and psychiatric screening. Patients also undergo psychosocial assessments. The systems of support for the patient are evaluated. The cultural and ethnic aspects are also considered during the evaluation.
The overall assessment process should be engaging. This will help the patient cope with the current circumstances. The process of assessment sets the basis for treatment. With a proper and suitable assessment of the dual patient, the treatment process is made easier and effective. Following through the process also prepares the patient for treatment. In addition, the patient will also undergo reassessment. Medical practitioners should also consider the combination of the dual disorder throughout the procedure. Screening tests also play a significant role in understanding the condition of the patient.
Assessment checklist
Appearance, anxiety, consciousness, emotions
- Appearance:
What is the general outlook of the patient and effect on health such as personal hygiene dressing? Does the poor hygiene affect the general outlook and health of the patient?
- Consciousness:
Does the patient pay attention or has a low attention span? What is the level of alertness in dangerous situations like while driving and in public places?
- Anxiety:
What is the frequency of periods of anxiety, nervousness and panic, how do they affect the individual and other people?
- Emotions:
Is the person emotionally unstable, crying or easily angered, can or has the person harmed anyone?
Behavior
- Communication:
How does the person talk, content, rate of speech? Do they talk to others angrily and threatening them especially after AOD use?
- Purpose
Is the person dangerous, impulsive, bizarre, and attempted to commit suicide? Are these behaviors psychological or influenced by AOD use?
- Movements
I the person hyperactive and undertake dangerous movements in risky areas such as pools and buildings?
Cognition
- Reasoning
Does the person have poor judgment leading to misunderstandings, conflicts and disagreements with or without AOD use?
- Coherence
Does the individual have hallucinations, delusions and incoherent ideas? Are they influenced by AOD use?
Reference
Ries, R., & U.S. Department of Health and Human Services. (2001). Assessment and treatment of patients with coexisting mental illnes and alcohol and other drug abuse. Rockville, MD: U.S. Department of Health and Human Services.
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