Intervention Tip #2 - Assessing the Severity of the Addiction

This is the second article of an intervention tips series. Continue reading with the first and third tips articles -  Tip 1: Avoiding Distractions and Debate.and Tip 3. Assessing Treatment Need.

You have to understand the problem before you can find a solution, but with addiction, this is a lot easier said than done...

To plan an intervention and to pre-arrange treatment you need to evaluate the severity of the situation.

You may find this difficult, since:

1. You are probably not an addiction treatment or mental health professional.
2. Substance use disorders (abuse and addiction) occur along a spectrum of severity, so unfortunately, you can't just say "he/she has a problem" - you have to figure out how serious it is too.
   

But though assessing the problem is challenging, you can’t run an effective intervention unless you know what you’re facing. Getting an accurate assessment of the severity of the problem helps you to:

1. Convince hold-out relatives, who may try to minimize the extent of the problem
2. Gain more understanding (and compassion) for what your loved one struggles with
3. Pre-arrange an appropriate level of treatment
   

How to Assess the Severity of the Situation

Firstly, you have to decide whether to enlist professional help or assess on your own.

Hiring a professional offers some significant advantages, such as:

• A professional brings experience and knowledge to the situation and likely improves your chances of correctly assessing the situation.
• Since an outsider doesn’t have an emotional history or connection to the family, she is neutral and unbiased (lacking a personal agenda). This may help all family members to receive her recommendations more openly.
• If you say there’s a problem, some family members may dispute your ability to make that judgment. If an outside expert, with legitimate authority diagnoses a problem, other family members are more likely to accept her determinations.

So in situations where family members disagree about the extent of the problem or where no one feels able to assess the situation, a professional can provide a lot of clarity and unity.

How to Find a Professional

You can contact any local (respected) addiction treatment program to find a qualified assessment professional.They will likely have an in-house staff member that can help you with an assessment, and if they don’t, they can almost surely recommend someone to help you.

So why might you not consult a professional?

• If money’s an issue, you need to think hard about how to best allocate your resources. In some cases, you may want to reserve that money to pay for treatment.

Assessing on Your Own

You won’t have to make the final determination about a level of care; this is likely beyond your level of expertise. Should your loved-one decide to initiate treatment, they will get a formal substance use assessment and receive a recommended level of care and treatment plan.

However, to zero in on what's needed, you will still want to understand the severity of the situation. The 2 assessment tools you’ll find below can help you with this. They are:

1. A severity of addiction related consequences assessment test (designed for family members).
2. The American Society of Addiction Medicine’s (ASAM) placement criteria – a tool professionals use to help determine an appropriate level of care.

The first test will help you to gain an understanding of the severity of the problem and the consequences related to use, and the placement criteria will help you gain a basic understanding of what variables influence your loved-one’s treatment needs.

Assessing the Severity of Consequences

Take a few minutes to answer the 34 questions assessment test below. It’s a test similar to one that clinicians give to family members when trying to evaluate the severity of a drug or alcohol use disorder. This test can be helpful for family members considering an intervention for a couple of reasons, such as:

1. It may help you to determine the severity of the problem - The more yes answers you score, the greater the negative consequences associated with use and the more serious the situation.
2. It provides a framework to help you consider the drinking or drug use. In most interventions you list examples of the harms you've observed. So whenever you answer yes to a question in the test below, you may want to think of specific behavioral examples that illustrate your answer. You can then choose from these examples later when planning your spoken contribution for the intervention.

The Severity of Addiction Related Consequences Test¹

Choose a response (yes or no) that best answers the question. If unsure, just answer to the best of your knowledge.

For simplicity’s sake, we will frame the test toward a male subject and use ‘he’, but the test is equally valid for both men and women.

1. Has he ever been hung-over or sick after drinking or drug use?
2. Has he ever gotten sick or thrown-up after drinking or taking drugs?
3. Has his drinking or drug use ever caused him to miss days at work or school?
4. Has he ever performed worse at school or work due to his drinking or drug use?
5. Has the drinking or drug use ever compromised his parenting?
6. Have family or friends ever complained or felt worried about the drinking or drug use?
7. Does he ever drink and drive or drive while high?
8. Does the drinking or drug use cause him to have poor eating habits (many alcoholics can become malnourished from ‘liquid meals’, many stimulant abusers may lose weight as they skip too many meals…)?
9. Has the drinking or drug use caused him to fail to meet responsibilities?
10. When drinking or using drugs, does his personality ever worsen (he becomes a person you like less)?
11. When drinking or using drugs does he ever do embarrassing things he would not otherwise do?
12. Does he ever take ill-considered risks when drunk or high?
13. Does he ever get into any kind of trouble because of his drug use or drinking?
14. Has his drinking or drug use ever caused him to speak cruelly or aggressively to someone else?
15. Has he ever seriously damaged a close friendship or relationship with a family member because of the drinking or drug use?
16. Has he ever lost a close friend because of his use of drugs or alcohol?
17. Has the drinking or drug use ever led to the destruction of a serious romantic relationship?
18. Has he ever regretted something impulsive he did while drunk or high?
19. Has he ever been in a physical fight while drunk or high?
20. Has the drinking or drugs harmed his health?
21. Has he ever had financial problems because of his drinking or drug use?
22. Has the drinking or drug use negatively affected his appearance?
23. Has his drinking or drug use caused any serious harm to his family?
24. Has his drinking or drug use ever led to jail or prison time?
25. Has he stopped doing things he used to enjoy because of his drinking or drug use?
26. Has he ever been arrested for DUI or DWI?
27. Has he ever had legal problems other than a DWI or DUI related to his drinking or drug use?
28. Has his drug or alcohol use damaged his reputation, popularity or social standing?
29. Has his drinking or drug use ever led to him spending or losing a great deal of money?
30. Has he ever been suspended or fired – or otherwise compelled to leave a job due to the drinking or drug use?
31. Has he ever been in an accident while drunk or high?
32. Has he ever been seriously physically hurt while drunk or high?
33. Has he ever seriously hurt another person while drunk or high?
34. Has he ever destroyed property while drunk or high?

The ASAM Addiction Treatment Placement Criteria²

The test above helps you to understand how the substance abuse affects quality of life. The placement criteria below may help you to understand what's needed to get better.

Addiction treatment isn't a one-size fits all type of care. Some of the more common care options include:

• Outpatient detoxification
• Residential non-medical detoxification
• Residential medical detoxification
• Evening outpatient classes
• Full-day outpatient program (returning home in the evenings)
• Residential care (most commonly known as ‘rehab’)
• Hospitalization

When considering what level of care fits the situation, professionals use the following 6 evaluation criteria:

1. Acute intoxication and withdrawal risks

Is the person coming into treatment while still high/drunk? Are complicated or dangerous withdrawal symptoms expected or possible? Yes answers to either question indicate a need for a higher intensity of care, such as possibly a residential medical detoxification.

2. Other health or medical problems or complications

All things being equal, a person with a serious co-occurring physical health condition may need a greater intensity of care than a generally physically healthy person.

3. Co-occurring mental-health or cognitive conditions or complications

People with mental illness generally require treatment which addresses addiction and mental health at the same time. Mental illness complicates treatment.

4. Readiness to change

A person who is ready and motivated to change may not require the same intensity of treatment as a person starting from a place of ambivalence.

5. Ability to maintain abstinence and avoid relapse

People who cannot maintain even short periods of abstinence are not good candidates for outpatient treatment.

6. Social and living environment (conducive to recovery?)

People lacking a safe and sober living environment generally require residential treatment, at least at the start.

Continue reading for the first and third tips articles -  Tip 1: Avoiding Distractions and Debate.and Tip 3. Assessing Treatment Need.