Getting Help For Addiction
If you are suffering from a substance use disorder, you are not alone. Unfortunately, these conditions are remarkably prevalent. For this reason, thousands of treatment centers across the U.S. have been established to lend a helping hand to individuals like you.
Harmony Treatment and Wellness employs highly-skilled addiction professionals who provide services clinically-proven to be beneficial for the recovery process, including behavioral therapy, counseling, group support, and more.
Our team of caring specialists is dedicated to helping each client achieve recovery by providing them with the tools and support they need to prevent relapse and sustain long-term sobriety and wellness.
You dont have to suffer alone! Call us today to discuss treatment options and learn how we can help you break the cycle of addiction for the rest of your life!
Severity Readiness To Change And Alcohol Withdrawal Assessment Instruments
Once an AUD diagnosis is established there are several well-validated instruments that enhance the practitioner’s ability to measure functional disability and disease severity associated with alcohol consumption. Their use is beyond the scope of this review, but the Addiction Severity Index and the Drinker Inventory of Consequences are often used . There exists several instruments to assess readiness to change unhealthy alcohol behaviors . Instruments include the Stages of Change Readiness and Treatment-Eagerness Scale and the University of Rhode Island Change Assessment Scale .
Primary care patients may present in a state of alcohol withdrawal. It is unlikely that an assessment of AUD diagnosis is useful in alcohol withdrawal. In this situation, the patient may not be competent to answer questions and physiologic alcohol dependence is inherently met. The Clinical Interview and Withdrawal Assessment Scale-Alcohol Revised is an essential tool to assess the severity of withdrawal, trigger pharmacotherapy and other medical interventions, and, if needed, specialty referral or treatment .
University of Rhode Island Change Assessment , for drug-using adults
biological methods, including breath tests, urinanalysis, and blood tests, to determine substance use
Linda S. Kranitz, … Ned L. Cooney, in, 2009
Potential Uses Of The Asi
Administrative initiatives toward a routine use of the ASI are often supported by bold promises. It is therefore germane to evaluate how realistic and practical are the promises.
According to the literature, the ASI has been used or is meant to be used for a wide variety of clinical, administrative and research purposes .
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The Dsm 5 Has Eleven Criteria For Substance Use Disorders Based On Decades Of Research
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, is the American Psychiatric Associations goldstandard text on mental health that was crafted by hundreds of mental health experts.
The DSM-5 has eleven criteria, or symptoms, for substance use disorders based on decades of research. The DSM-5 has helped change how we think about addictions by not overly focusing on withdrawal.
Three Levels of Severity
The DSM-5 includes guidelines for clinicians to determine how severe a substance use disorder is depending on the number of symptoms. Two or three symptoms indicate a mild substance use disorder; four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder. A severe SUD is also known as having an addiction.
Doctors determine the severity level of the substance use disorder to help develop the best treatment plan. The higher the severity, the more intensive the level of treatment needed.
Most patients are likely to need ongoing treatment and recovery support using a chronic care model for several years. A doctor should monitor progress and adjust the plan as needed.
Like other illnesses, addiction gets worse over time. Similar to stages of cancer, there are levels of severity to describe a substance use disorder.
Asi Composite Scores And The Measurement Of Treatment Effects
There are reasons to believe that ASI composite scores are particularly inadequate as instruments for the measurement of treatment effects. Usually, no data are presented on which particular items produce the treatment effect. However, in one study an examination of alcohol and drug composite scores showed that practically all changes between measures at intake and at 6-month follow-up were due to changes in the client’s subjective evaluation of the severity of his problems and his need for additional treatment. The authors conclude: By combining more subjective information with more objective information, it becomes difficult to identify exactly what changes with treatment.
At intake, most clients are motivated to agree that they need treatment. Six months later they are much less likely to report that they need additional treatment.
An additional complication is that depending on the ideology of the treatment programme and on how well the patient has internalized its tenets, people with no current alcohol or drug use may assess differently their need for continuous treatment. Many sober and clean members of AA and NA, for example, may feel that they have been troubled or bothered in the past 30days by alcohol and drug problems or that they need continuous treatment.
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Original Asi Summary Indices
The designers of the ASI developed two summary indices for each problem areainterviewer severity ratings and composite scores . In the ISRs, interviewers follow a complicated procedure to establish a rating of the severity of need for additional treatment in each area. A first estimate is made on the basis of quantitative information provided by the respondent. The critical items reflect, to a large extent, life-time problems. The manual instructs the interviewer to determine a 23-point severity range along a 10-point scale. Next, the interviewer has to refine this estimate using the patient’s subjective ratings of the current importance of the problem and the need for treatment .
The composite scores are summary scores of a defined set of items in each area. The composite scores only include items that are subject to change .
The number of items included in each composite score varies from three to 13 . With the exception of the employment area, all composite indices include two items measuring how troubled or bothered the respondent has been by problems in each area in the past 30days and how important it is for the client to receive treatment, counselling or referral for problems.
In EuropASI, modifications have been made in the method of calculating the composite scores, but they still include both purposefully subjective and purportedly objective questions . In the Swedish version, the calculation of composite scores follows the American model .
How The Asi Works
The ASI focuses on the big picture. It takes into consideration that addiction to drugs or alcohol can result from life events that precede, occur at the same time as, or result from substance abuse problems. Rather than focusing on the clients substance abuse, the ASI highlights seven potential problem areas. It covers medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. This broad overview helps to determine the clients level of stability. It has also proven useful for understanding life events that contribute to alcohol and drug dependency.
The Addiction Severity Index is a 1 hour face-to-face interview that takes place when a client is admitted for treatment. The ASI interviewer collects data in two parts: lifetime severity ratings and 30 day composite scores.
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The Asi And Customized Treatment Plans
Addiction Severity Index data is one tool that addiction treatment providers have to evaluate the individual needs of those who seek recovery. Today, more than ever before, a person entering treatment is not only assessed for their addiction-related needs but also deeper, underlying issues. These issues contribute to the development of addiction and dramatically increase the likelihood of relapse if left unaddressed.
The development of a customized treatment plan ensures that the person in recovery will receive a full spectrum of care. Proper treatment should improve the clients overall health, as well as provide them with the resources they need to prevent relapse and mend broken or strained relationships with family and friends.
You can find a copy of the Addiction Severity Index here.
The Addiction Severity Index
The ASI provides a general overview of issues related to substance abuse, rather than concentrating on any specific area. An individuals input is crucial because it allows healthcare providers to devise the safest and most effective treatment plan. Any information recorded in the ASI is confidential.
In each of the aforementioned areas, you will be asked to answer questions based on a 1-5 scale, and how bothered you are by problems in each area. You will also be asked how important you believe treatment is for you in those areas.
The scale looks like this:
1 Not at all4 Considerably5 Extremely
You have the right to refuse to answer any question, especially if you consider the topic to be too personal, uncomfortable, painful, or traumatic. Keep in mind, however, that there are benefits to answering as many questions as possible and also truthfully because this information will be used to design a comprehensive treatment plan that is appropriate for your individual needs.
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Research On The Idc/gdc Models
These treatment manuals were developed for use in the National Institute on Drug Abuse Cocaine Collaborative Study. This was a multicenter investigation examining the efficacy of four psychosocial treatments for cocaine-dependent patients. Four hundred and eighty-seven patients were randomly assigned to one of four manual-guided treatments: IDC plus GDC, cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Primary outcome measures were the Addiction Severity IndexDrug Use Composite score and the number of days of cocaine use in the past month. Compared with the two psychotherapies and with GDC alone, IDC plus GDC showed the greatest improvement on the Addiction Severity IndexDrug Use Composite score and on number of days of cocaine use in the last month. Overall, compared with professional psychotherapy, IDC was more effective at reducing cocaine use in this study.
Sharon Dawe, … Natalie J. Loxton, in, 2013
Why Does The Asi Matter
An evaluative tool such as the ASI is important because substance abuse is a complex condition that is affected by many factors and also has repercussions that impact many areas of a persons life. The more information that a person involved in your treatment has about your individual circumstances, the better informed they will be when they design a plan for you.
These programs operate much differently than say,;12-step support groups. They have the potential to address every aspect of a persons health and emotional well-being in addition to substance abuse. For example, if you also struggle with maintaining employment or have legal issues, a devised recovery plan can be more focused on how to overcome these difficulties.
Substance abuse often causes damage to relationships, self-esteem, and a wide variety of life aspects that can be addressed if a treatment planner has information that helps to see the importance of these issues in your life. In other words, the ASI offers an interviewer a complete picture of what an individuals life is like and how substance abuse fits into that life and affects it.
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Different Drug Of Choice Different Addiction Severity
As a society, we tend to judge the severity of an addiction mostly on the substance, a.k.a. the drug of choice. There are some addictions that are seen as being relatively harmless, such as an addiction to video games, coffee, or even binge eating, while other addictions are perceived as being far more serious, such as opioid addiction or IV drug use.
Unfortunately, the general perception that some addictions have significantly more adverse impacts on the addict than other less serious addictions can keep people from seeking treatment for their addictive behaviors. Its common for someone who is a high-functioning alcoholic to have difficulty seeing themselves as having a substance abuse problem, while someone who is injecting heroin tends to readily agree that they have an addiction to drugs.
Treatment approaches also differ based on the drug of choice for obvious reasons. While all forms of addiction cause an imbalance in ones life, some addictions are actually life-threatening.
Onsite Substance Abuse Testing
In this way, personal evaluations may not be enough. Onsite substance abuse testing removes all subjectivity for an objective measurement. Urinalysis is a preferred method of determining whether someone has taken a substance with the last three days or up to 30 days for cannabis. The time frame of such tests make them effective for identifying short-term use, but they lack the foresight of whether abuse is a longstanding issue or not. Put simply, there is no laboratory test for dependence or addiction.
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The Alcohol Use Disorder And Associated Disabilities Interview Schedule
The AUDADIS provides for current and lifetime DSM-IV diagnoses of major mood, anxiety, personality, and substance use disorders. Originally developed by the National Institute on Alcohol Abuse and Alcoholism for use in population-based epidemiological surveys, the fully structured AUDADIS functions as an economical tool that lay staff in treatment programs can administer for intake screening. Clinicians can use the detailed descriptive data obtained by the AUDADIS to structure treatment based on a patients specific substance-related behaviors. In addition to alcohol, tobacco, and other drug use, modules address treatment and family history. Numerous queries address the frequency and quantity of use of each type of alcohol and each illicit drug during three time periodsthat of heaviest use, the past 12 months, and the interviewees lifetime ).
The AUDADIS showed high reliability in a test-retest study in clinical settings where comorbidity was expected to be high . Its test-retest reliabilities for alcohol and drug consumption, abuse, and dependence, as well as those for other modules, were good to excellent . The AUDADIS interview can be downloaded . The instruments developers recommend using the computer-assisted version.
Studies Of The Reliability And Validity Of The Addiction Severity Index
Finnish Foundation for Alcohol Studies, Finland
Finnish Foundation for Alcohol Studies, Finland
Aims To examine the reliability and validity of the widely used Addiction Severity Index .
Material Thirty-seven studies of the psychometric performance of the ASI.
Findings The inter-rater and testretest reliabilities of the severity ratings and composites scores vary from excellent to unsatisfactory. High internal consistencies have been reported regularly for only three of the seven composite scores . The remaining four composite scores have low consistencies in at least four different studies. Coefficients of criterion validity are often low.
There is a discrepancy between the psychometric performance of the ASI and its purported clinical, administrative and research uses.
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Reliability And Validity Of The Asi
Overall, studies typically conclude that the Addiction Severity Index is a consistent and accurate tool for assessing clients and their substance abuse issues. The ASI is able to successfully identify the clients problem area in which they are experiencing the greatest difficulties, such as alcohol or drug addiction, or legal or familial problems. Once a clients psycho-social issues are identified, an appropriate course of treatment may be administered.
One study notes additional useful applications of the ASI. These include predicting the treatment outcome, comparing different forms of treatment, and the ability to match a client with a specific treatment. However, as society changes, future studies of the ASI will be needed to demonstrate its value as an important assessment tool.
The Composite International Diagnostic Interview
The CIDI, originally developed by the World Health Organization, assesses 22 DSM-IV diagnoses, including mood, anxiety, and substance use disorders ). For each substance use disorder, the CIDI elicits other information useful for treatment planning, such as the patterns and course of alcohol and drug use. The fully structured instrument takes approximately 120 minutes to administer in its entirety .
Various versions and adaptations of the original CIDI have been developed. The University of Michigan version, the UM-CIDI, has been used in a large international epidemiological survey , but appears to produce lower prevalence estimates than other diagnostic instruments . To address this problem and others related to earlier versions of the CIDI, the World Mental Health Survey Initiative Version, the WMH-CIDI, was developed . A complete description of WMH-CIDI modifications is reported elsewhere . The WMH-CIDI is available in paper and computerized forms for download or computer-assisted administration at www.hcp.med.harvard.edu/wmhcidi/instruments.php.
Alcohol Use Screening From the Structured Clinical Interview for DSM
Sources: ; .
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A Basic Menu Of Assessment Instruments
Of the instruments we discuss here, the ASI and CIDI make up the common assessment battery of the National Institute on Drug Abuse Clinical Trials Network , which conducts studies to evaluate evidence-based treatment interventions in widely diverse community-based treatment settings and patient populations nationwide. Prior to adopting these measures, a CTN workgroup evaluated many measures for reliability, validity, efficiency, and suitability for widespread use in nonresearch settings.
The Addiction Severity Index As A Predictor Of The Use Of Mental Health Care
The Addiction Severity Index has been extensively used in the United States and Europe as an indicator of the problems of substance abuse patients. Several studies have shown the ASI to be a reliable and valid instrument, but lately doubt has arisen regarding its validity and reliability. The article focuses on a specific scale of the ASI–the Psychiatric Status scale–and its strength in predicting the use of mental health care. A group of 1,027 heroin patients in Rotterdam, the Netherlands, who participated in a methadone program were the subjects. Three indices have been used: the evaluation index, the clinical index, and the composite scores. It appears that no matter which indices are used, the Psychiatric scale does discriminate between those who will have contact with mental health care and those who will not. However, the percentage of false positives is high. None of the indices predicts the intensity and duration of the mental health care treatment.
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