110 -Assessment of Addiction and Mental Health Issues
Counselor Toolbox

 
 
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Assessment: Identifying the Problem
Objectives
~ Define screening and assessment
~ Define the purpose of assessment
~ Explore the steps in the assessment
~ Recognize the stage of change a client is in with regards to mental health and substance abuse and utilize this towards creating a treatment plan.
~ Learn about the first steps in moving toward happiness

Why Is This Important
~ 47% of US Adults suffers from maladaptive signs of an addictive disorder over a 12-month period
~ Co-Occurring Disorders are the EXPECTATION not the Exception
~ Statistics indicate that the majority of people seen in mental health treatment struggle with addictive behaviors.
~ Refer for treatment or treat yourself
Screening and Assessment
~ Screening is a very quick process which can be done by
~ Physicians
~ Coaches
~ Specialists/Techs
~ Counselors
~ Screening simply determines if there may be a need for further evaluation.
Purpose of Assessment
~ To identify symptoms
~ Explore the course of the symptoms
~ Identify exacerbating and mitigating factors
~ Determine the impact of symptoms
~ Identify change goals
~ Develop an action plan based on identified goals
Assessment Provides Awareness of SNAP
 Strengths
◦ Resources
◦ Skills
◦ Mitigating Factors and exceptions
 Needs
◦ Biological
◦ Safety
◦ Love and Belonging
 Attitudes
◦ About recovery
◦ Cultural

Awareness of SNAP
~ Preferences
~ Learning style
~ Treatment approach
~ Quality of Life

5 Principles of Motivational Interviewing
 Generate a Gap
 Roll with Resistance
 Avoid Arguing
 Can Do
 Express Empathy

Stages of Readiness for Change
~ Most people have multiple issues
~ Readiness for change can be different for each issue—even each symptom of each issue
~ Stages
~ Precontemplation
~ Contemplation
~ Preparation/Determination
~ Action
~ Maintenance (needs attention when addressing new issues)
Addiction (vs. Recreational Use)
~ Tolerance need more to get the same rush, high or feeling.
~ Withdrawal: Anxiety, irritability, shakes, sweats, nausea, depression when unable to access the addiction
~ Negative consequences: Continued to use even though there have been negative consequences.
~ Neglected or postponed activities because of your use?
~ Significant time or energy spent obtaining, using, concealing, planning, or recovering from your use.
~ Unsuccessful attempts to cut down or control your use
Chemical and Behavioral
~ Addictive behaviors causes a “flood” of neurochemicals
~ This flood contributes to an imbalance
~ Like a “hangover” occasional use does not necessarily alter brain functioning
~ Repeated use causes the brain to shut down certain pathways so it is not constantly being flooded (tolerance)
~ Many other issues such as pre-existing anxiety or depression can indicate a pre-existing neurochemical imbalance which is being self-medicated
~ Requires additional stimulation to produce the same relief because many fewer “doors” are open
Mental Health
~ Depression/Hopelessness/Apathy
~ Anxiety/Worry
~ Difficulty Concentrating
~ Irritability
~ Agitation
~ Fatigue
~ Changes in sleep duration or quality
~ Changes in eating

First Steps
~ Identify the Problem
~ Identify the Solution
~ Learn about what causes the problem in general
~ Learn about what causes the problem for you
~ Learn about possible solutions
~ Identify solutions that will work for you
~ Develop a plan to start implementing those solutions
Presenting Problem
~ Presenting problem
~ What are your symptoms (as evidenced by)
~ How long has each been going on
~ What makes it worse
~ What makes it better
~ What are the consequences of each symptom (as evidenced by)

Resolution/Goal
~ What does happiness look like for you?
~ What will be different?
~ Emotionally
~ Mentally
~ Physically
~ Socially (self-esteem, relationships and recreation)
~ Environmentally
~ What will be the same?

Transactional Model
~ The way you feel emotionally or physically impacts:
~ How you interact with others
~ Your stress response
~ Your attitude and ability to concentrate
~ Your environment
~ Each one of those things also impacts how you feel
Evaluate potential causes of the symptoms
~ Physical
~ Sleep
~ Nutrition
~ Pain/Illness
~ Sunlight
~ Exercise
~ Addiction
~ Alcohol
~ Anxiety
~ Depression
~ Tremors
Evaluate potential causes of the symptoms
~ Physical
~ Addiction
~ Amphetamines, cocaine and other stimulants can trigger
~ Anxiety, panic
~ Depression (withdrawal)
~ Tremors
~ Marijuana can trigger
~ Anxiety
~ Apathy/Lack of motivation
~ Impaired concentration
~ Paranoid delusions/hallucinations

Evaluate potential causes of the symptoms
~ Physical
~ Addiction
~ Opiates
~ Depression
~ Decreased pain tolerance
~ Disruption of circadian rhythms

Evaluate potential causes of the symptoms
~ Age
~ Many physiological changes take place as a result of age. Taking this into account can assist in determining some of the possible causes of symptoms
~ Younger people have fewer experiences against which to judge current experiences
~ The culture and environment changes for people of different ages.
Evaluate potential causes of the symptoms
~ Social
~ Your immediate family
~ Social supports
~ Stressors
~ Self-Esteem
~ Environmental
~ Active/Interruptions vs. Calm/Peaceful
~ Supportive of sleep?
~ Supportive of relaxation?
Evaluate potential causes of the symptoms
~ Emotions
~ Anger
~ Anxiety
~ Depression
~ Happiness
~ Thought triggers for each emotion

Symptom Assessment
Symptom Assessment: Lenny
Next Step
~ Work on becoming mindful of your symptom triggers
~ Do a mindfulness scan prior to each meal to identify how you feel and what you need…
~ Emotionally
~ Mentally
~ Physically
Summary
~ The Assessment is really the beginning point
~ It helps clients get a clearer idea of what may be causing their symptoms or making them worse.
~ Proper nutrition, adequate quality sleep and pain management are all necessary for happiness and recovery
~ At this stage clients are starting to envision what happiness looks like for them.
~ Help them identify their strengths and what things are good uses of their energy
Summary
~ Identify which presenting symptoms the client is most willing to work on a develop a treatment plan from there
~ From the perspective of the transactional model, improving any area will likely improve the person’s overall happiness
~ The symptom assessment chart can help identify current strengths and possible contributors to the symptom.

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