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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
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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
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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
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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
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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
[email protected]