In substance abuse treatment, an accurate diagnosis is the key to developing an effective, personalized care plan. In order to identify the root causes of a patient’s addiction, mental health professionals use a number of diagnostic tools, including face-to-face interviews, reviews of patient records, interviews with family members, and standardized tests. To ensure that the treatment plan truly reflects the patient’s needs, and that therapy is effective, assessments are performed at the admission stage and during the later stages of rehab. Testing may also be performed at discharge to measure the patient’s progress in treatment and to choose the best aftercare services for the individual.
Why is an accurate diagnosis so important?
Neuropsychological evaluation is one of the most important components of a comprehensive care plan. Without a thorough understanding of the patient’s psychological status, psychiatric history, and cognitive function, a rehab program probably will not be successful. Many of the patients who enter rehab have been affected not only by addiction, but also by other conditions that may influence their treatment, such as:
- Mood disorders
- Personality disorders
- Anxiety disorders
- Learning disabilities
- Behavioral disorders
- Brain injuries
Any of these conditions can interfere with the progress of rehab if they go undiagnosed. For instance, a patient suffering from ADHD (attention deficit hyperactivity disorder) may have difficulty sitting through therapy sessions or focusing on recovery goals. An individual with depression may have a profound lack of energy and low motivation to attend rehab activities. A person with a traumatic brain injury may have trouble recalling information or communicating effectively with staff.
A study published in the Journal of Psychoactive Drugs shows that neuropsychological testing in substance abuse treatment can lead to improvement in patient outcomes. Patients enrolled in a two-week rehab program were given neurocognitive tests on admission and during treatment. Nearly two-thirds of the patients showed impairment in memory, attention, abstract thinking, and other cognitive skills. At discharge, patients were tested again, and many showed improvement in attention, communication skills, and abstraction.
Diagnosis makes it possible for doctors, therapists, nurses, and other members of the treatment team to provide the best possible care for the individual patient, regardless of the challenges that he or she faces.
- How is a diagnosis determined?
- Who can make a diagnosis?
- How are mental illness and substance use disorder diagnosis?
Once the necessary information has been gathered, a diagnosis is determined in several steps:
- By reviewing patient reports, records, and test results to compile a set of symptoms
- By analyzing the patient’s symptoms and comparing them to the symptoms described in the DSM-V
- By finding out how long the symptoms have lasted.
- By determining whether the symptoms could be attributed to another psychological or medical condition (The process of selecting the most accurate diagnosis from several alternatives is known as a “differential diagnosis.”)
Psychiatric diagnoses are not always correct, and they may be revised over the course of a patient’s treatment. Unlike diseases that affect the body — such as diabetes, heart disease, cancer, or liver failure — psychiatric disorders can’t be diagnosed through lab tests, physical assessments, or radiologic exams. Instead, mental health specialists and substance abuse treatment professionals must rely on their interviewing skills and on the results of standardized exams to determine a diagnosis that accurately reflects the patient’s concerns.
Many of the longer, commonly used neuropsychological tests require specialized training to administer them correctly. However, there are many simple screening tools and short self-reported tests that can be administered by doctors, nurses, counselors, and other professionals in a variety of settings. These tests can be useful at identifying the warning signs of mental illness or addiction, so that the patient can be referred to a more advanced level of care for psychiatric services or addiction treatment.
- Many of the symptoms of substance abuse (impulsive behavior, confusion, depression, suicidal ideation, paranoia, psychosis, etc.) closely resemble the signs of mental illness.
- Substance abuse may mask the symptoms of mental illness, especially if the patient has learned to manage the condition with drugs or alcohol.
- Substance abuse can trigger or worsen the symptoms of an underlying mental illness, such as depression, schizophrenia, or an anxiety disorder.
- Mental illness may lead to drug or alcohol abuse as a form of self-medication if the patient has not received proper treatment.
In the admission stage, a period of detox is often required to cleanse the body and clear the mind. Once the drugs or alcohol have been cleared from the patient’s system, the treatment team can determine a diagnosis more easily. After detox, patients may respond more accurately to interviews and testing. Medically stable patients may also be more emotionally stable, which gives the provider a more realistic assessment of their baseline in face-to-face interviews.
The DSM includes a separate classification for substance-related and addictive disorders, such as alcohol use disorder, stimulant use disorder, and gambling disorder. However, according to the American Psychological Association, up to 60 percent of individuals who struggle with substance abuse also have a form of mental illness — a condition known as co-occurring disorders, comorbid disorders, or a dual diagnosis.
Mental illness can make the effects of substance abuse more severe, and vice versa. Mental illness can pose barriers to treatment unless the patient receives the right therapeutic interventions. Identifying and treating patients with a dual diagnosis is one of the most important goals of rehab.
What tests are used for diagnosis?
Neuropsychological testing can help disengage the symptoms of a substance use disorder from mental illness. There are many diagnostic tools that can be used to determine whether the patient’s primary concern is a psychiatric illness or a substance use disorder. In addition to psychological and neurological tests, professionals can use personality assessments to identify potential barriers to recovery and develop an effective course of treatment. Diagnostic instruments fall into a number of categories, including:
- Intelligence tests
- Cognitive tests
- Projective tests
- Self-reported psychological tests
- Structured and semi-structured interviews
- Screening tools
- Personality tests
- Aptitude tests
In order to make a correct diagnosis, professionals usually administer not just one test, but rather a series of tests known as a “battery.” Some of the most commonly used tests in substance abuse treatment are listed below:
- ASI (Addiction Severity Index): Now in its fifth edition, this standardized interview was first developed in 1972 and is still considered to be one of the most reliable screening instruments in the field of substance abuse treatment. The ASI can be administered before, during, and after treatment to measure the extent of a drug or alcohol abuser’s substance use as well as his or her medical, psychological, and social issues.
- AUDADIS-IV (Alcohol Use Disorder and Associated Disabilities Interview Schedule, Fourth Edition): This screening instrument was designed as a survey tool by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The AUDADIS is often administered at the intake stage to assess the patient’s substance abuse, family background, and psychiatric history.
- Beck Depression Inventory and Beck Anxiety Inventory: Designed by Aaron T. Beck, a psychiatrist at the University of Pennsylvania, the Beck Depression Inventory and Beck Anxiety Inventory are among the most popular tools for assessing mood and psychological status. These brief, self-reported tests ask the patient to respond to a series of questions that reflect his or her mental status. The Beck Scales are especially useful in the application of cognitive behavioral therapy (CBT), which focuses on transforming negative thought patterns into positive, constructive ones.
- MAST (Michigan Alcoholism Screening Test) and DAST (Drug Abuse Screening Test): The Michigan Alcoholism Screening Test was developed in 1971, but it is still considered to be one of the most accurate tools for diagnosing alcoholic behavior. This self-reported screening tool consists of a series of questions about the patients drinking habits and attitudes toward alcohol. In 1982, the MAST was followed by the DAST, or Drug Abuse Screening Test, which performs the same function for drug users. The MAST and DAST are easy to administer and to score, and can be given to patients in a variety of settings to identify a potential problem with drugs or alcohol.
- Meyers-Briggs Type Indicator: Developed by the mother-daughter team of Katharine Cook Briggs and Isabel Briggs Myers, this psychometric questionnaire has become a popular instrument for assessing personality. The test, which is based on the philosophy of Carl Jung, categorizes human personality according to four basic psychological functions: feeling, thinking, sensation, and intuition. The Meyers-Briggs Type Indicator, or MBTI, is based on the premise that one of these functions is predominant most of the time, and that the individual’s personality type reflects the way he or she interacts with the world and perceives experience.
- MMPI-II (Minnesota Multiphasic Personality Inventory II): The first edition of this diagnostic tool was published by the University of Minnesota in 1943; the most recent version was issued in 1989. This standardized psychometric test is used to assess personality, identify signs of psychopathology, and to develop differential diagnoses.
- PRISM-CV-IV (Psychiatric Research Interview for Substance and Mental Health Disorders): Developed by psychiatric professionals at Columbia University and the New York State Psychiatric Institute, the PRISM-CV-IV consists of a series of modules that test for a number of major mental health and addictive disorders. This diagnostic tool, which takes the form of a semi-structured interview, is one of the most widely used tests in identifying co-occurring disorders.
- Rorschach Test: Also known as the “inkblot test,” the Rorschach is the most widely known and commonly used projective tests. Projective tests use the patient’s perceptions, or projections, of symbols or stories to identify signs of thought disorders or to analyze personality traits. Initially developed by Swiss psychoanalyst Hermann Rorschach in 1921, the Rorschach Test is based on the patient’s analysis of a series of abstract inkblots.
- SCID-I and SCID-II (Structured Clinical Interview for DSM-IV Axis I Disorders and Axis II Disorders): Developed by Columbia University, the SCID is a semi-structured interview used to diagnose Axis I (clinical categories of mental illness) and Axis II (personality and developmental disorders) disorders. There are several versions of this diagnostic instrument, designed to address different conditions.
- WAIS-IV (Wechsler Adult Intelligence Scale, Fourth Edition): The WAIS-IV is one of the most frequently used tools for testing intelligence in adults and adolescents. Specifically, the WAIS measures the individual’s ability to think rationally and interact effectively and purposefully with his or her environment. Psychologist David Wechsler published the first version of the test in 1955.
- YMRS (Young Mania Rating Scale): First published in 1978, the Young Mania Rating Scale is a short questionnaire used to assess the severity of mania in adults or children with bipolar disorder. This brief but effective test consists of 11 questions, which evaluate the patient’s mood, energy levels, sleep patterns, sexual impulses, and other factors that may identify a manic episode.
What happens after you receive a diagnosis?
Receiving a psychiatric diagnosis is just the first step in the journey of recovery. The treatment team will use this diagnosis as a basis for developing a program that meets the patient’s needs. Based on the diagnosis, the treatment team can do the following:
- Develop a therapeutic protocol for the individual patient
- Determine whether the patient needs treatment for co-occurring disorders
- Assess the patient’s psychosocial needs (social, legal, financial, and interpersonal)
- Identify potential barriers to treatment
- Estimate the appropriate duration of treatment
- Assign therapists, case managers, and other staff members to participate in the patient’s care
Treatment planning is an ongoing, flexible process. Diagnostic testing begins at the admission stage and may continue throughout treatment to ensure that the initial treatment plan is meeting the patient’s needs. If the patient is not making progress, the program — and perhaps the diagnosis — must be reviewed and revised to improve the outcome.
The addiction specialists at The Recovery Village are uniquely equipped to handle the challenges of treating patients with co-occurring issues. We provide comprehensive, thorough neuropsychological testing at the time of admission to ensure that we develop the most effective care plan for the individual. Call our intake specialists today to learn more about how our specialized recovery programs can help you or a loved one overcome addiction and reach a new level of health and wellness.