Linking Assessment And Treatment The Decisiontree Procedure

A three-stage evaluation procedure provides a systematic framework for connecting assessment and treatment. The first stage involves brief screening using the DUSI-R (Tarter, 1990). At this stage, the areas of disturbance that point to the need for comprehensive evaluation are identified. In the second stage, a diagnostic evaluation is performed in the identified problem areas. This information in turn is applied to a focused, in-depth evaluation to formulate a multi-disciplinary treatment plan.

Using a decision-tree multistage evaluation procedure has several advantages:

• The areas of disturbance can be quickly identified at minimal cost.

• Labor-intensive, comprehensive diagnostic evaluation is guided by the results obtained in initial screening.

• The client's rehabilitation needs are clearly delineated, based on aggregate findings from the initial screening and the comprehensive diagnostic evaluation.

• Once the required treatment interventions are specified, a coordinated intervention program can be developed. In this fashion, evaluation and treatment are integrally linked in an ongoing reciprocal and interactive manner.

Matching assessment results with treatment is rapidly becoming standard clinical practice. For example, Annis and Graham (1995) link treatment planning, including relapse prevention counseling, to particular client profiles on the Inventory of Drinking Situations (IDS; Annis, 1982). The IDS categorizes heavy alcohol abusers into four types: (1) the negative profile—individuals whose alcohol abuse is a consequence of negative emotions (e.g., boredom, anxiety, and depression); (2) the positive profile—individuals who drink heavily due to social pressure, wanting to have a good time, or wanting to relax; (3) low-testing personal control—individuals whose abuse of alcohol is undif-ferentiated, possibly due to lack of motivation to change and lack of awareness of the antecedents of abuse; and (4) low physical discomfort—individuals who also presents with an undifferentiated profile characterized by limited use of alcohol. Substance abuse treatment is thus individualized according to the four IDS client profiles. For example, in the case of the negative and positive profilers, the focus of intervention is on teaching alternate ways of coping with social pressures and interpersonal conflicts, teaching alternate forms of relaxation, providing assertiveness training, and resolving interpersonal stress. The point to be made is that psychological assessment is not an intellectual exercise. Rather, the information should be applied to improving treatment outcome. Toward that goal, psychological evaluation is pertinent to determining the client's readiness for treatment, designing the most appropriate treatment, monitoring change during the course of treatment, documentation of individual outcome, and determining effectiveness of the treatment program.

REFERENCES

Achenbach, T., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington: University of Vermont, Department of Psychiatry.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.

Annis, H. M. (1982). Inventory of Drinking Situations (IDS-100). Toronto: Addiction Research Foundation of Ontario.

Annis, H. M., & Graham, J. M. (1995). Profile types on the Inventory of Drinking Situations: Implications for relapse prevention counseling. Psychol Addict Behav, 9, 176-182.

Barrabee, R., Barrabee, E. L., & Finesinger, J. E. (1955). A normative social adjustment scale. Am J Psychiatry, 112, 252-259.

Beavers, W. R., & Hampson, R. B. (1990). Successful families: Assessment and intervention. New York: Norton.

Buchsbaum, M., & Ludwig, A. (1980). Effects of sensory input and alcohol administration on visual evoked potentials in normal subjects and alcoholics. In H. Begleiter (Ed.), Biological effects of alcohol. New York: Plenum Press.

Carroll, J. F. (1983). Substance Abuse Problem Checklist manual. Eagleville, PA: Eagle-ville Hospital.

Costello, J., Edelbrock, C., & Costello, A. (1984). The reliability of the NIMH Diagnostic Interview Schedule for Children: A comparison between pediatric and psychiatric referrals. Pittsburgh, PA: Western Psychiatric Institute and Clinic.

Dackis, C. A., Gold, M. S., Pottash, A. L. C., & Sweeney, D. R. (1985). Evaluating depression in alcoholics. Psychiatry Res, 17, 105-109.

Daley, D., Moss, H. B., & Campbell, F. (1987). Dual disorders: Counseling clients with chemical dependency and mental illness. Center City, MN: Hazelden.

Derogatis, L. R. (1983). SCL-90-R: Administration, scoring and procedures manual II (rev.) . Towson, MD: Clinical Psychometric Research.

Dodes, L. M. (1990). Addiction, helplessness, and narcissistic rage. Psychoanal Q, 59, 398-419.

Epstein, N. B., Baldwin, L., & Bishop, D. (1983). The McMaster Family Assessment Device. J Marital Fam Ther, 9, 213-228.

Epstein, S. (1976). Anxiety, arousal and the self-concept. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and anxiety. Washington, DC: Hemisphere.

Epstein, S. (1987). The constructive thinking inventory. Amherst: University of Massachusetts, Department of Psychology.

Ewusi-Mensah, I., Saunders, J., & Williams, R. (1984). The clinical nature and detection of psychiatric disorders in patients with alcoholic liver disease. Alcohol Alcohol, 39, 297-302.

Finn, P., Sharkansky, E., Brandt, K., & Turcotte, N. (2000). The effects of familial risk, personality, and expectancies on alcohol use and abuse. J Abnorm Psychol, 109, 122-133.

Folkman, S., & Lazarus, R. (1980). An analysis of coping in middle aged community sample. J Health Soc Behav, 21, 219-239.

Golden, C. J. (1981). A standardized version of Luria's neuropsychological tests. In S. Filskov & T. J. Boll (Eds.), Handbook of clinical neuropsychology. New York: Wiley-Interscience.

Goldstein, G., Tarter, R., Shelly, C., & Hegedus, A. (1983). The Pittsburgh Initial Neuropsychological Testing System (PINTS): A neuropsychological screening battery for psychiatric patients. J Behav Assess, 5, 227-238.

Grant, I., Adams, K., & Reed, R. (1979). Normal neuropsychological abilities of alcoholic men in their late thirties. Am J Psychiatry, 136, 1263-1269.

Haertzen, C. A. (1974). An overview of Addiction Research Center Inventory scales (ARCI): An appendix and manual of scales (DHEW Publication No. ADM 74-92). Rockville, MD: National Institute on Drug Abuse.

Handelsman, L., Cochran, K. J., Aronson, M. J., Ness, R., Rubinstein, K. J., & Kanof, P. D. (1987). Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse, 13, 293-308.

Hathaway, S. R., & McKinley, J. C. (1951). The Minnesota Multiphasic Personality Inventory manual (rev.). New York: Psychological Corporation.

Helzer, J. E., & Pryzbeck, T. R. (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud

Alcohol, 49, 219-224.

Henly, G., & Winters, K. (1988). Development of problem severity scales for the assessment of adolescent alcohol and drug abuse. Int J Addict, 23, 65-85.

Hunt, S. M., McEwen, J., & McKenna, S. P. (1985). Measuring health status: A tool for clinicians and epidemiologists. J R Coll Gen Pract, 35, 185.

Jacobson, G., Pisani, V., & Berenbaum, H. (1970). Temporal stability of field dependence among hospitalized alcoholics. J Abnorm Psychol, 76, 10-12.

Kaminer, Y., Bukstein, O. G., & Tarter, R. E. (1991). The Teen Addiction Severity Index: Rationale and reliability. Int J Addict, 26, 219-226.

Kandel, D. (1975). Stages in adolescent involvement in drug use. Science, 190, 912-914.

Karp, S., Kissin, B., & Hustmeyer, F. (1970). Field-dependence as a predictor of alcoholic therapy dropouts. J Nerv Ment Dis, 15, 77-83.

Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. Am J Psychiatry, 142, 1259-1264.

Kirisci, L., Hsu, T., & Tarter, R. (1994). Fitting a two-parameter logistic item response model to clarify the psychometric properties of the Drug Use Screening Inventory for adolescent alcohol and drug abusers. Alcohol Clin Exp Res, 18, 1335-1341.

Kissin, B., Platz, A., & Su, W. (1970). Social and psychological factors in the treatment of chronic alcoholism. J Psychiatr Res, 8, 13-27.

Lezak, M., Howieson, D., & Loring, D. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.

Loney, J., & Milich, R. (1982). Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich & D. Routh (Eds.), Advances in developmental and behavioral pediatrics. Greenwich, CT: JAI Press.

Mann, R. E., Sobell, L. C., Sobell, M. B., & Pavan, D. (1985). Reliability of family tree questionnaire for assessing family history of alcohol problems. Drug Alcohol Depend, 15, 61-67.

Manuzza, S., Fryer, A. J., Endicott, J., & Klein, D. F. (1985). Family Informant Schedule and Criteria (FISC). New York: New York State Psychiatric Institute.

McClain, C., Potter, T., Krombout, J., & Zieve, L. (1984). The effect of lactulose on psychomotor performance tests in alcoholic cirrhotics without evert encephalopathy. Clin Gastroenterol, 6, 325-329.

McFarlane, A. H., Neale, K. A., Norman, G. R., Roy, R. G., & Steiner, D. L. (1981). Methodological issues in developing a scale to measure social support. Schizophrenia Bull, 7, 90-100.

McLellan, A. (1986). "Psychiatric severity" as a predictor of outcome from substance abuse treatments. In R. E. Meyer (Ed.), Psychopathology and addictive disorders (pp. 97-139). New York: Guilford Press.

McLellan, A., Luborsky, L., Woody, G., & O'Brien, C. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Scale Index. J Nerv Ment Dis, 168, 26-33.

Moos, R. (1974). Combined preliminary manual for the family, work, and group environment Scales. Palo Alto, CA: Consulting Psychologists Press.

Moos, R., & Moos, B. (1981). Family Environment Scale manual. Palo Alto, CA: Consulting Psychologists Press.

Morral, A., McCaffrey, D., & Paddock, S. (2002). Reassessing the marijuana gateway effect. Addiction, 97, 1493-1504.

Nixon, S. J. (1999). Neuropsychological assessment. In P. Ott, R. Tarter, & R. Ammerman (Eds.), Sourcebook on assessment and treatment (pp. 227-235). Boston: Allyn & Bacon.

Oetting, E., Beauvais, F., Edwards, R., & Waters, M. (1984). The drug and alcohol assessment system. Fort Collins, CO: Rocky Mountain Behavioral Sciences Institute.

Olson, D. H., McCubbin, H. I., Barnes, H. L., Larsen, A. S., Muxen, M. J., & Wilson, M. A. (1989). Families: What makes them work (updated ed.). Newbury Park, CA: Sage.

Olson, D. H., Russell, C. S., & Sprenkle, D. H. (1980). Circumplex model of marital and family systems: II. Empirical studies and clinical intervention. In J. Vincent (Ed.), Advances in family intervention, assessment and theory (Vol. I, pp. 129-179). Greenwich, CT: JAI Press.

Olson, D. H., Russell, C. S., & Sprenkle, D. H. (1983). Circumplex model of marital and family systems: VI. Theoretical update. Fam Process, 22, 69-83.

Orvaschel, H., Puig-Antich, J., Chambers, W., Tabrizi, M. A., & Johnson, R. (1982). Retrospective assessment of prepubertal major depression with the Kiddie-SADS-E. J Am Acad Child Adolesc Psychiatry, 21, 392-397.

Parkerson, G. R., Gehlbach, S. H., Wagner, E. H., James, S. A., Clapp, N. E., &

Muhlbaier, L. H. (1981). The Duke-UNC Health Profile: An adult health status instrument for primary care. Med Care, 19, 806-809.

Parsons, A., & Farr, S. (1981). The neuropsychology of alcohol and drug abuse. In S. Filskov & T. Boll (Eds.), Handbook of clinical neuropsychology (pp. 320-365). New York: Wiley.

Peace, K., & Mellsop, G. (1987). Alcoholism and psychiatric disorder. Aust NZ J Psychiatry, 21, 94-101.

Pelham, W. E., & Murphy, D. A. (1987). The DBD rating scale: A parent and teacher rating scale for the disruptive behavior disorders of childhood in DSM-III-R. Unpublished manuscript, University of Pittsburgh.

Reitan, R. (1955). An investigation of the validity of Halstead's measures of biological intelligence. AMA Arch Neurol Psychiatry, 73, 28-35.

Robins, L., Helzer, J., Croughan, J., & Ratcliff, K. (1981). National Institute of Mental Health Diagnostic Schedule: Its history, characteristics and validity. Arch Gen Psychiatry, 38, 381-389.

Rounsaville, B. J. (1993). Overview: Rationale and guidelines for using comparable measures to evaluate substance abusers. In B. J. Rounsaville, F. M. Tims, A. M. Horton, & B. J. Sowder (Eds.), Diagnostic source book on drug abuse research and treatment (pp. 1-10). Rockville, MD: National Institute on Drug Abuse.

Schooler, C., Zahn, T., Murphy, D., & Buchsbaum, M. (1978). Psychological correlates of monoamine oxidase activity in normals. J Nerv Ment Dis, 166, 177-186.

Selzer, M. (1971). The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument. Am J Psychiatry, 127, 1653-1658.

Shaffer, H. J. (1992). The psychology of stage change: The transition from addiction to recovery. In J. H. Lowinson, P. Ruiz, & R. B. Millman (Eds.), Substance abuse: A comprehensive textbook (pp. 1019-1033). Baltimore: Williams & Wilkins.

Skinner, H. A. (1982). The Drug Abuse Screening Test. Addict Behav, 7, 363-371.

Skinner, H. A., Steinhauer, P. D., & Santa Barbara, J. (1983). The Family Assessment Measure. Can J Commun Ment Health, 2, 91-105.

Spear, L. (2000). The adolescent brain and age-related behavioral manifestations. Neurosci Biobehav Rev, 24, 417-463.

Spitzer, R. L., Endicott, J., & Robins, E. (1975). Clinical criteria for psychiatric diagnosis and DSM-III. Am J Psychiatry, 132, 1187-1192.

Spitzer, R. L., Williams, J. B. W., & Gibbon, M. (1987, April 1). Instruction manual for the Structured Clinical Interview for DSM-III-R (rev.). New York: New York State Psychiatric Institute.

Steinglass, P., Bennett, L., Wolin, S., & Reiss, D. (1987). The alcoholic family. New York: Basic Books.

Steinhauer, P. D., Santa-Barbara, J., & Skinner, H. A. (1984). The process model of family functioning. Can J Psychiatry, 29, 77-88.

Stewart, A. L., Hays, R. D., & Ware, J. E. (1988). The MOS short form general health survey: Reliability and validity in a patient population. Med Care, 27, S12-S26.

Sugerman, A., & Schneider, D. (1976). Cognitive styles in alcoholism. In R. Tarter & A. Sugerman (Eds.), Alcoholism: Interdisciplinary approaches to an enduring problem (pp. 395-433). Reading, MA: Addison-Wesley.

Tarter, R. (1990). Evaluation and treatment of adolescent substance abuse: A decision tree method. Am J Drug Alcohol Abuse, 16, 1-46.

Tarter, R., Alterman, A., & Edwards, K. (1985). Vulnerability to alcoholism in men: A behavior genetic perspective. J Stud Alcohol, 46, 329-356.

Tarter, R., & Edwards, K. (1985). Neuropsychology of alcoholism. In R. Tarter & D. Van Thiel (Eds.), Alcohol and brain: Chronic effects. New York: Plenum Press.

Tarter, R., & Edwards, K. (1987). Brief and comprehensive neuropsychological assessment of alcoholism and drug abuse. In L. Hartlage, M. Ashen, & L. Hornsby (Eds.), Essentials of neuropsychological assessment (pp. 138-162). New York: Springer.

Tarter, R., Edwards, K., & Van Thiel, D. (1986). Hepatic encephalopathy. In G. Goldstein & R. Tarter (Eds.), Advances in clinical neuropsychology (Vol. 3, pp. 243263). New York: Plenum Press.

Tarter, R., & Kirisci, L. (1997). The Drug Use Screening Inventory for adults: Psychometric structure and discriminative sensitivity. Am J Drug Alcohol Abuse, 23, 207219.

Tarter, R., & Kirisci, L. (2001). Validity of the Drug Use Screening Inventory for predicting DSM-III-R substance use disorder. J Child Adolesc Subst Abuse, 10, 45-53.

Tarter, R., Kirisci, L., Habeych, M., Reynolds, M., & Vanyukov, M. (2004). Neuro-behavior disinhibition predisposes to early age onset substance use disorder: Direct and mediated etiologic pathways. Drug Alcohol Depend, 73, 121-132.

Tarter, R., Kirisci, L., Mezzich, A., Cornelius, J., Pajer, K., Vanyukov, M., Gardner, W., & Clark, D. (2003). Neurobehavior disinhibition in childhood predicts early age onset substance use disorder. Am J Psychiatry, 160, 1078-1085.

Tarter, R., & Ryan, C. (1983). Neuropsychology of alcoholism: Etiology, phenomenology, process and outcome. In M. Galanter (Ed.), Recent developments in alcoholism (pp. 449-469). New York: Plenum Press.

Tarter, R., Van Thiel, D., & Moss, H. (1988). Impact of cirrhosis on the neuropsychological test performance of alcoholics. Alcohol Clin Exp Res, 12, 619-621.

Tarter, R., Vanyukov, M., Giancola, P., Dawes, M., Blackson, T., Mezzich, A., & Clark, D. (1999). Etiology of early age onset substance abuse: A maturational prospective. Dev Psychopathology, 11, 657-683.

Tellegen, A. (1982). A manual for the Differential Personality Questionnaire. Unpublished manuscript.

Tellegen, A. (1985). Structures of mood and personality and their relevance to assessing anxiety with an emphasis on self-report. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders. Hillsdale, NJ: Erlbaum.

Tellegen, A., Lykken, D., Bourchard, T., Wilcox, K., Segal, N., & Rich, S. (1988). Personality similarity in twins reared apart and together. J Pers Soc Psychol, 54, 10311039.

Van Hasselt, V. B., Hersen, M., & Milliones, J. (1978). Social skills for alcoholics and drug addicts: A review. Addict Behav, 3, 221-233.

Vanuyukov, M., Tarter, R., Kirisci, L., Kirillova, G., Maher, B., & Clark, D. (2003). Liability to substance use disorders: 1. Common mechanisms and manifestations. Neurosci Biobehav Rev, 27', 507-515.

Vernon, P., Lee, D., Harris, J., Jang, K. (1996). Genetic and environmental contributions to individual differences in alcohol expectancies. Pers Individ Dif, 21, 183187.

Von Knorring, A., Bohman, M., Von Knorring, L., & Oreland, L. (1985). Platelet

MAO activity as a biological marker in subgroups of alcoholism. Acta Psychiatr Scand, 72, 51-58.

Wanberg, K., & Horn, J. (1985). The Alcohol Use Inventory: A guide to the use of the paper and pencil version. Fort Logan, CO: Multivariate Measurement Consultants.

Weissman, M. (1988). Anxiety and alcoholism. J Clin Psychiatry, 49, 17-19.

Wellner, Z., Reich, W., Herjanic, B., Jung, D., & Amado, K. (1987). Reliability, validity and parent-child agreement studies of the Diagnostic Interview for Children and Adolescents (DICA). J Am Acad Child Adolesc Psychiatry, 26, 649-653.

Wilkinson, D., & Carlen, P. (1980). Relationship of neuropsychological test performance to brain morphology in amnesic and non-amnesic chronic alcoholics. Acta Psychiatr Scand, 62, 89-102.

Woody, G. E., Luborsky, L., McLellan, A. T., O'Brien, C. P., Beck, A. T., Blaine, J., et al. (1983). Psychotherapy for opiate addicts: Does it help? Arch Gen Psychiatry, 40, 639-645.

Zuckerman, M., Bone, R., Neary, R., Mangelsdorff, D., & Brastman, B. (1972). What is the sensation seeker?: Personality and trait experience correlates of the Sensation Seeking Scales. J Consult Clin Psychol, 39, 308-321.

Natural Depression Cures

Natural Depression Cures

Are You Depressed? Heard the horror stories about anti-depressants and how they can just make things worse? Are you sick of being over medicated, glazed over and too fat from taking too many happy pills? Do you hate the dry mouth, the mania and mood swings and sleep disturbances that can come with taking a prescribed mood elevator?

Get My Free Ebook


Post a comment