Calidad

Drug history and current patterns of use: When did alcohol or other drug use begin? What types of alcohol or other drugs does the individual currently use? Does the person use over-the-counter medications, prescription drugs, tobacco, and caffeine? How frequently are the substances used and in what quantity?

Substance abuse treatment history: Has the individual ever received treatment for substance abuse? If so, what type of treatment (inpatient, outpatient, methadone maintenance, Twelve-Step programs, etc.)? Were these treatment experiences considered successful or unsuccessful and why? Has the person been sober and experienced relapse, or has s/he never attained recovery?

Medical history and current status: What symptoms are currently reported by the patient? Are there indicators of infectious and/or sexually transmitted diseases? Has the individual been tested for HIV and other infectious diseases? Are there indicators of risk for HIV or other diseases for which testing should be done? What kind of health care has been received in the past? The causes and effects of various illnesses and traumas should be explored.

Mental status and mental health history: Is the individual orientated to person, place, and time? Does s/he have the ability to concentrate on the interview process? Are there indicators of impaired cognitive abilities? What is the appropriateness of responses during the interview? Is the person's affect (emotional response) appropriate for the situation? Are there indicators from collateral sources of inappropriate behavior or responses by the person? Is there evidence of extreme mood states, suicidal potential, or possibility of violence? Is the individual able to control impulses? Have there been previous psychological or psychiatric evaluations or treatment?

Personal status: What are this person's critical life events? Who constitute his/her peer group? Does the individual indicate psychosocial problems that might lead to substance abuse? Does the person demonstrate appropriate social, interpersonal, self-management, and stress management skills? What is the individual's level of

self-esteem? What are the person's leisure time interests? What are his/her socioeconomic level and housing and neighborhood situation?

Family history and current relationships: Who does the individual consider his/her family to be; is it a traditional or nontraditional family constellation? What role does the individual play within the family? Are there indicators of a history of physical or sexual abuse or neglect? Do other family members have a history of substance abuse, health problems or chronic illnesses, psychiatric disorders, or criminal behavior? What is the family's cultural, racial, and socioeconomic

background? What are the strengths of the family and are they invested in helping the individual? Have there been foster family or other out-of-home placements?

Positive support systems: Does the person have hobbies, interests, and talents? Who are his/her positive peers or family members?

Crime or delinquency: Have there been previous arrests and/or involvement in the criminal or juvenile justice system? Has the person been involved in criminal or delinquent activity but not been apprehended? Is there evidence of gang

involvement? Is the person currently under the supervision of the justice system? What is the person's attitude about criminal or delinquent behavior?

Education: How much formal education has the person completed? What is the individual's functional educational level? Is there evidence of a learning disability? Has s/he received any special education services? If currently in school, what is the person's academic performance and attendance pattern?

Employment: What is the individual's current employment status? What

employment training has been received? What jobs have been held in the past and why has the person left these jobs? If currently employed, are there problems with performance or attendance?

Readiness for treatment: Does the patient accept or deny a need for treatment? Are there other barriers to treatment?

Resources and responsibilities: What is the individual's socioeconomic status? Is the person receiving services from other agencies, or might s/he be eligible for services?

(Doweiko, 1990; McLellan & Dembo, 1992; Tarter, Ott & Mezzich, 1991)

Minimal training is usually required to administer standardized interviews. To administer structured interviews, interviewers must have knowledge and experience in working with similar populations, as well as expertise in interviewing. The goal of this interview is to obtain as much information as possible about the person. Therefore, the interviewer is expected to probe beyond superficial or conflicting answers. Structured interviews usually take more time to administer and interpret than standardized interviews.

Self-Administered Tests. Usually, less staff skill is required with self-administered tests than with structured or standardized interviews. On the other hand, these tests require some motivation and reading ability on the part of the individual being assessed. Many instruments are written at the fourth or fifth grade reading level. Moreover, self-administered tests are only credible if the person is willing to answer the questions honestly. However, written tests can be helpful for those who have difficulty speaking directly about themselves. These instruments provide an indirect and, for some, less threatening method of self-disclosing information. They also prevent interviewer bias and, like other standardized instruments, can be scored and quantified. Reliability and validity measures usually are available as well.

Data Analysis

Once information is gathered, it is interpreted for use in decision making. During this phase,

professional service providers determine the severity of the person's alcohol or drug problem, possible contributing factors, and his or her readiness for intervention.

The professional conducting or managing the assessment process will use all of the collected data to arrive at an opinion about the individual's substance abuse problem. The question to be answered is: Do the data indicate that the person is addicted to or dependent on one or more chemicals, an abuser of chemicals, or not adversely affected by occasional use of drugs and/or alcohol? (Doweiko, 1990). The analysis must encompass the range of problems, strengths and sources of support available to the person. It also should address factors that have contributed to or are related to alcohol and other drug abuse (McLellan & Dembo, 1992).

Treatment Plan Development

The findings from the assessment process and monitoring of treatment should be documented to enhance clinical case supervision. The data derived from the screening and assessment processes form the basis of a treatment plan. This plan must recognize the unique constellation of problems and other factors that have been identified for the individual. The treatment plan will recommend a course of action that attempts to address the patient's unique needs. Implementation of the plan will involve providing or referring the person to appropriate treatment programs and monitoring his or her progress. A single treatment modality or a combination of services may be needed. The treatment plan should be comprehensive, containing information about the following categories:

the identified problems to be addressed;

the goals and objectives of the treatment process (e.g., to help the individual abstain from use of drugs, to help the patient resolve underlying self-esteem problems, to help the person achieve full employment);

the resources to be applied (i.e., treatment programs, funding, other services, etc.); the persons responsible for various actions (e.g., making referrals, attending

treatment sessions, follow-up reports);

the time frame within which certain activities should occur; and

the expected benefits for the person who will participate in the treatment experience.