Dimensional Assessment for Co-Occurring Disorders 8 th 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)