Assessment and Diagnosis

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Assessment and Diagnosis

Assessment and Diagnosis 2

Assessment

Assessment forms the first point of contact for the

counsellor with the client

Assessment and Diagnosis 3

Assessment: Benefits

Planningmanagement

Diagnosis

Screening

Referral

Motivation enhancement

Establish Rapport

Assessment and Diagnosis 4

Stages of assessment

Assessment is not a one-time phenomenon

Assessment and Diagnosis 5

Assessment – tools

Clinical: Through history and examination

Investigations Performing certain tests

Instruments Use of standard tools/questionnaire

for assessment

Assessment and Diagnosis 6

Clinical assessment

Means of clinical assessment Interaction with patient / client

Interaction with family member / companion

Examination

Previous treatment records

Assessment and Diagnosis 7

Socio-demographic profile Name Age Sex Marital status Qualification Occupation Type of family Place of residence

Clinical Assessment – History

Assessment and Diagnosis 8

Details of drug use Type of drug currently being used: the

class of the drug (e.g. opioid) and the particular chemical composition (e.g. buprenorphine); in case the chemical composition is not understood, the local name used should be noted

Frequency and amount of drug currently used

Mode of use of the drug currently used Last dose of drug used

Clinical Assessment – History

Assessment and Diagnosis 9

Physical: health hazards associated with IDU

Local: redness/swelling at injecting site, wounds, sores, blocked veins, etc.

Systemic: hepatitis, lung diseases (e.g. chronic bronchitis), etc.

Clinical Assessment – History

Legal: involvement in illegal

activities to obtain drugs (e.g. thefts, pick pocketing)

Arrests/detainment by police

Charges under NDPS act for drug using/dealing

Driving under intoxication with drugs

Physical fights under intoxication of drugs

Complications associated with drug use

Assessment and Diagnosis 10

Clinical Assessment – History

Occupational – financial

Inability to work productively

Accidents at workplace Frequent absenteeism Loss of job Frequent change of job Loss of income, Debts

Psychological Guilt & shame Anxiety Depression

Complications associated with drug use

Assessment and Diagnosis 11

Clinical Assessment – History

Marital/Familial/social Fights with family Neglect of household

responsibility Physical violence Outcast from family Separation/divorce Homelessness Stigmatisation in society

Complications associated with drug use

Assessment and Diagnosis 12

High risk behaviors

Clinical Assessment – History

Injection Related Sex Related

Assessment and Diagnosis 13

Injecting related risk behaviors: Sharing of needles Sharing of syringes, cotton, vials, or

other paraphernalia Cleaning practices Sites of injection use iv/im; any

dangerous sites of use Reuse of needles and syringes Places where injections are taken Needle site complications

Clinical Assessment – History

Assessment and Diagnosis 14

Sex related risk behaviors: Sexual intercourse without condoms Multiple sexual partners Sexual intercourse with female sex

workers Anal intercourse Sex with a person who has STIs Sex under the influence of drugs/alcohol Sex work for procuring drugs

Clinical Assessment – History

Assessment and Diagnosis 15

HIV related knowledge and beliefs Knowledge on HIV

What is HIV? How is HIV transmitted? Name the 4 modes of

transmission of HIV What is the difference between HIV and AIDS? What happens when one is infected with HIV? Does one gets HIV by touching and kissing? Does one gets HIV by sharing food of others? Can HIV be cured? Can HIV be prevented? How?

Ask open ended questions

Clinical Assessment – History

Assessment and Diagnosis 16

History of referrals sought, esp. ICTC, STI clinic, Detoxification and other drug

treatment services, Tuberculosis centre

Clinical Assessment – History

Assessment and Diagnosis 17

History of any medical illness & details

History of any mental illness & details

Current living arrangements Social support Motivation level

Clinical Assessment – History

Assessment and Diagnosis 18

Evidence of drug use with respect to Intoxication Withdrawals Route of drug use

Evidence of physical damage due to drug use Systemic examination

Clinical Assessment – Examination

Assessment and Diagnosis 19

Assessment - Investigations

Two types To assess the degree of physical

damage Hemogram, Liver function test, Renal

function test, HIV, Hep B & C

To confirm the presence / absence of drugs in the body

Screening of body fluids, most commonly urine

Assessment and Diagnosis 20

Assessment – Instruments

Structured set of questions to assess an individual

Act to validate assessment across time, place and person

Examples Addiction Severity Index Clinical Opiate withdrawal scale CAGE

Assessment and Diagnosis 21

Diagnosis should include the following: Primary drug status Secondary drug status Physical co-morbidity Psychological morbidity Psychosocial issues

Diagnosis

Assessment and Diagnosis 22

Drug status: Drug use syndromes Abuse/Misuse Dependence Intoxication

Diagnosis

Assessment and Diagnosis 23

Drug status: Drug use syndromes Dependence Abuse/Harmful use Intoxication

Diagnosis

Assessment and Diagnosis 24

Definition “A cluster of physiological, behavioural and

cognitive phenomenon in which use of a substance or class of substance takes on a much higher priority for an individual than other behaviours…..”

Three or more criteria to be present for some time in a one-year period.

Diagnosis of drug dependence

Assessment and Diagnosis 25

1. Tolerance: Need for increasing the amount of substance

consumed to achieve intoxication or the desired effect

Markedly diminished effect with continued use of the same amount of substance

Example A person ‘X’ started with one line of heroin smoking

to get intoxicated; with time, he had to increase the dose to 1 pudiya per day to get the same amount of intoxication

A person ‘Y’ started with one peg of whisky and got high; with continued use, has to now consume 3 pegs of whisky to get the same high

Diagnosis of drug dependence: Criteria

Assessment and Diagnosis 26

2. Withdrawals Set of symptoms experienced on

stopping or reducing the amount of the substance after prolonged use

Every class of substance (e.g. alcohol, opioids, etc.) has its own unique set of withdrawal symptoms

Diagnosis of drug dependence: Criteria

Assessment and Diagnosis 27

Diagnosis of drug dependence: Criteria

E.g. opioid withdrawal Early symptoms

Anxiety Restlessness Yawning Nausea Sweating Running nose Running eyes Dilated pupils Abdominal

cramps

Delayed symptoms Severe Anxiety Restlessness Diarrhea Vomiting Muscular spasm,

pain Chills Increased heart

rate, blood pressure Increased

temperature

Assessment and Diagnosis 28

Diagnosis of drug dependence: Criteria

E.g. Alcohol withdrawal Anxiety Restlessness Increased heart

rate Increased

breathing Shaking

(tremors) of hands and other body parts

Sweating Sleeplessness Inability to concentrate Delirium tremens

Confusion; disorientation to time, place and person; visual hallucinations; illusions; delusions

Seizures / fits

Assessment and Diagnosis 29

3. Impaired control of behaviour associated with substance use in terms of its starting the use of the substance, stopping the use of the substance, or controlling the level of use

ExampleA person ‘X’ had thought that he would consume

only 1 peg of alcohol on a given day, but he is not able to stop after 1 peg, but continues to take more than peg: loss of control

A person ‘Y’ planned to stop his drug use, but is unable to do so: loss of control

Diagnosis of drug dependence: Criteria

Assessment and Diagnosis 30

4. Preoccupation with the use of substance: manifested as:

Great amount of time spent in using the substance/procuring the substance/recovering from the effect of the substance

Other activities which were pleasurable are given up as a result of the substance use

Other interests/hobbies given up due to indulgence in substance use

Diagnosis of drug dependence: Criteria

Assessment and Diagnosis 31

5. Continuing use of the particular substance despite harmful consequence of the substance on the individual

6. Strong desire to use the substance: Craving

Craving can be spontaneous or in reaction to certain stimulus (e.g. place where the individual takes drugs, drug using friends, shop where the individual purchases drugs/alcohol, etc.). The craving in reaction to stimulus is called as ‘cue induced’ craving.

Diagnosis of drug dependence: Criteria

Assessment and Diagnosis 32

Drug status: Drug use syndromes Dependence Abuse/Harmful use Intoxication

Diagnosis

Assessment and Diagnosis 33

Harmful use: A pattern of use of substance, in which

there is evidence of damage to the health of the individual

The damage can be physical or mental health damage

Abuse: used in the USA system A pattern of substance use, in which there

is damage to legal, social and occupational spheres of the individual’s life, in addition to the physical sphere.

Drug abuse/harmful use

Assessment and Diagnosis 34

Drug status: Drug use syndromes Dependence Abuse/Harmful use Intoxication

Diagnosis

Assessment and Diagnosis 35

Opioid intoxication

Mental/Behavioural effects

Drowsiness Initial euphoria

(happiness) Dysphoria (irritable

mood) Impaired judgement Impaired performance Agitation or

retardation Impaired attention Hallucinations

Physical Slurred speech Slow respiration Slow pulse Stupor/coma Pupillary constriction Pupillary dilation

(anoxic)

Assessment and Diagnosis 36

Alcohol intoxication

Mental/Behavioural effects

Drowsiness Impaired attention Impaired judgement Impulsive behaviour Inappropriate sexual

behaviour Aggression Impaired performance Easy irritability or

happiness Stupor / coma

Physical Flushed face Headache Rapid pulse Sweating Slurred speech Motor in-coordination Unsteady gait Respiratory depression

Assessment and Diagnosis 37

Assessment is a skill, and improves with practice

For successful outcome of an assessment: Establish rapport with the client Have non-judgemental attitude Effective communication Patient listening Maintain and reassure confidentiality of the

response Inform the client about the benefits of

carrying out detailed assessment

For successful assessment

Assessment and Diagnosis 38

Time for Role play …..