Chemical Dependency Assessment
The purpose of conducting a chemical dependency assessment is to determine the severity of the clients problem based on symptoms and longevity of symptoms in order to determine the best interventions.
When conducting an assessment of someones alcohol or drug use it is helpful to understand the clients goal for seeking professional services. Their answer should be a part of your clinical consideration.
There are a few common reasons why a person seeks professional services.
• To stop use due to the progression of consequences. In other words, it has finally got bad enough and the person knows he or she cannot continue using.
• To stop use because of potential consequences. Examples could be a person is threatened with loss of job and or ending of a relationship.
• To stop or limit use to get someone off his or her back. This may be an extension of the previous possibility. The person may want to get a partner, boss, probation officer, the court and or the Department of Motor Vehicles to leave him or her alone.
• To limit use to not accumulate consequences. To become a social drinker.
• To decide if the person does, in fact, have a problem with alcohol or drugs.
One of the first assessment considerations is whether the person will be in need of medical detox. Alcohol withdrawal, based on level and history of use, can bring life threatening problems and must be managed medically.
Someone deciding to detox or simply ‘white knuckle’ it at home is not always a wise or healthy activity. To ‘white knuckle’ means to sit on the couch and ride out the waves of potential nausea, vomiting, sweating, hallucinations, delirium, irritability and despair. Think of someone holding onto their roller coaster seat so tightly their knuckles turn white. Get the idea?
One must also consider that avoiding the suffering of withdrawal is one of the strongest reasons people continue using. A person in misery may easily decide to get high instead of putting themselves through more discomfort.
Different drugs have different lengths and severity of withdrawal. Alcohol, opiates, barbiturates, anti-anxiety agents, stimulants and nicotine bring very uncomfortable withdrawals. Marijuana brings a more mild withdrawal. Hallucinogens don’t provide much risk of withdrawal from long term use, because this class of drugs is not commonly used on a dependent basis.
Click Summary of Drug Classes and Effects for a one page chart covering the 8 major drug classes. This chart is made available from Project CORK.
If you are working with adolescents in a school or treatment setting you will find "Screening and Treating Adolescents for Substance Use Disorders" helpful. This 14 page publication is made available by the Substance Abuse Mental Health Services Administration.
Below are a standard set of questions you can use to conduct a chemical dependency assessment and evaluate the extent, severity and result of a person’s alcohol or drug use.
Please understand that if you do not have the needed education, training/license to render a diagnosis then don’t diagnose. If you are in training or under supervision always run your provisional diagnosis past your supervisor. An employer, or supervisor at work, should never diagnose or label someone, even if they are right, due to liability.
Click here for a printable checklist of DSM-IV Criteria for Substance Use Disorders made available from Project CORK.
Substance Abuse Assessment Questions
1. How much are you using?
2. What is the frequency of use?
3. Have there been any changes in frequency or amount of use? If not, how long has this amount and frequency of use been for?
4. What is your drug of choice?
5. Any history of poly substance use?
6. When was first use?
7. What has been the longest period of no use?
8. Have you ever tried to change the amount or pattern of your use in the past? What did you do?
9. Any family history of chemical dependency?
10. Have you ever been in formal treatment?
11. Are others concerned about your use?
12. Are you concerned about your use?
13. Have you experienced tolerance – the need to use more of the drug to create the same effect?
14. Do you ever experience withdrawal when not using?
15. When you come down from the drug, do you ever experience thoughts of wanting to hurt yourself? Have you ever done so?
16. When was your last physical exam, where there any problems?
17. Consequences fall into five categories. I’ll describe the category and you tell me if you have ever experienced problems in this area of your life due to your use.
18. What do you want to do differently, if anything, about your use?
When doing a more formalized chemical dependency assessment, I strongly urge you to do so only if you are competent (within your scope of education and training) to offer clinically sound suggestions for the person’s next steps. If you are unsure, or in the process of learning to conduct substance abuse assessments, seek consultation from a person who is certified or licensed in this field of study BEFORE you present your suggestions to the client.
Click here for a comprehensive list of alcohol and drug abuse screening and assessment instruments from the National Library of Medicine.
Click on my text Secrets of a Psychotherapist to learn the skills of a seasoned therapist that will help you develop confidence and resilience in this field.