Making an Informed Decision. How Can I Know What Kind of Treatment I Need for Alcoholism or Drug Abuse?
Of the 40,000,000 people in the United States who suffer from SUD, Substance Use Disorder, which includes Alcohol, only about 6-10% will get any help for their disease. This is because most people do not understand what “treatment” is, what levels there are and how to make an informed decision.
Knowing what “level of treatment” you need, is dependent on the professional evaluation of a qualified counselor who thoroughly understands and uses the tools identified below. This will save you money, time, and heartache and allow you to make the best decision for your needs.
The following is an explanation that will help you understand this process very thoroughly.
The American Society of Addiction Medicine (ASAM) was formed in the 1950s with the purpose of creating a high degree of understanding of the disease of addiction and assisting professionals working in the field of addiction to better understand the disease and help develop a recovery strategy that fits the specific needs of each individual seeking help.
It is estimated that as many as 40% of people become enrolled in a treatment program prior to becoming assessed to determine if that level of treatment is correct for them. An understanding of how evaluation works will assist you in getting to the right place with the right level of care for you.
When looking for a treatment program, ask if they use the ASAM Patient Placement Criteria. This is important because it tells you that a facility that is using this criterion is fully vested in achieving the correct level of care for you.
The criteria are developed along six dimensions of evaluation. Understanding each of these will help ensure that you get the help you need, at the right time and at the right place:
The Biopsychosocial Assessment
This involves a comprehensive assessment of all the biological, psychological, and social factors that can contribute to your specific treatment plan (the treatment plan is the course of help that is designed to meet your specific needs and history coming into a program.)
The biopsychosocial assessment will cover all 6 ASAM dimensions to ensure all the areas in your life are fully reviewed to identify any areas where specific interventions may be needed.
For example, you may require detoxification treatment to help you biologically withdraw from a particular substance, or you may require the support of psychological therapists so they can develop the necessary skills to cope with stressful situations instead of using substances.
The ASAM criteria can identify your individual strengths and the positive aspects in your life which can be valuable resources, as well as identifying any barriers to your ability to fully engage with treatment.
Who uses the ASAM criteria? Life Management Resources has used these criteria for every patient since 1999.
The ASAM criteria is a set of guidelines regarding the management, referral, treatment, placement, and discharge of patients with substance misuse disorders
The ASAM criteria can be used by any medical or mental health professionals working in the field to support them with their decision-making processes.
ASAM developed 6 dimensions which they propose medical professionals use to assess people referred to them.
The outcome of this assessment will assist in developing your treatment plan.
The 6 dimensions are listed below:
- Dimension 1 – Acute intoxication and/or withdrawal
- Dimension 2 – Biomedical conditions and complications
- Dimension 3 – Emotional, behavioral, or cognitive conditions and complications
- Dimension 4 – Readiness to change
- Dimension 5 – Relapse, continued use, or continued problem potential
- Dimension 6 – Recovery/living environment
Dimension risk ratings
Each dimension is assigned a risk rating by assessors ranging from 0, (low risk) to 4, (high risk).
The risk rating attributed to each dimension will help your counselor develop a course of treatment to address this area (if necessary).
If you are attributed a higher rating, then extra consideration should be given to this dimension when formulating your treatment plan.
The risk rating categories are as follows.
- 4 – Utmost severity, the threat of imminent danger
- 3 – Serious issue that needs addressing
- 2 – Moderate difficulty in functioning efficiently
- 1 – Mildly difficult
- 0 – No issue, very low risk
Dimension 1 – Acute intoxication and/or withdrawal
This dimension is concerned with assessing your current level of substance use and whether you are vulnerable to experiencing severe withdrawal symptoms, or if your physical health is in danger of rapidly deteriorating.
It will be necessary to measure the level of consumption of all the substances that you have a history of consuming and your current level of use over recent weeks.
It is important to know of any withdrawal symptoms you may be experiencing and the severity of such symptoms.
You can report to the counselor the severity of any withdrawal symptoms, or it may be that such symptoms are observable.
Particular care must be noted if you have a problem with alcohol dependence due to the potentially dangerous and life-threatening consequences of alcohol withdrawal.
It’s important to assess you for severe alcohol withdrawal if there are any suspicions that alcohol is a substance that you consume at high levels on a regular basis.
The assessment process in this dimension may result in you being referred to a detoxification treatment in an inpatient setting if your risk rating is too high.
Dimension 2 – Biomedical conditions and complications
This element of the assessment focuses on enquiring about any physical illnesses or conditions you may be diagnosed with that could negatively impact your ability to engage successfully with treatment. This does not mean that you will not get treatment, it simply means that any medical issues you have must be taken into account in developing your treatment plan so you will receive the best care possible.
This is essential, as being physically unwell may affect your mental health and reduces your ability to show the psychological resilience needed to maintain recovery.
This is of interest if you are pregnant or if you are managing any chronic medical conditions, such as diabetes or asthma.
A suitable care plan can then be developed to minimize the negative effects of these medical conditions on your substance misuse treatment plan.
It may well be that if you are receiving medical treatment that may interfere with your substance misuse treatment, or that any withdrawal symptoms you may experience could negatively impact your physical health conditions, these issues could be reported promptly to your medical care team.
Dimension 3 – Emotional, behavioral, or cognitive conditions and complications
The third dimension is concerned with assessing the emotional and psychological state you are in when first being evaluated by your counselor.
Psychological problems can play a key role in the development of an addiction and create barriers to the therapeutic and recovery process.
Therefore, it is extremely important that your counselor identify any emotional, behavioral, or cognitive complications which may require specific interventions.
For example, it may be that a person is showing signs that indicate an as yet undiagnosed mental health condition such as Depression, Bipolar Disorder, or Obsessive Compulsive Disorder, that these issues are thoroughly evaluated and treatment sought so that the recovery process overall is a success.
If this was the case medication or a specific psychological therapy may be prescribed.
For example, if the assessment reveals that you are finding it difficult to deal with previous traumatic experiences, it may be decided that you would benefit from trauma therapy. Your counselor trained in Trauma Informed counseling would include that as part of your treatment plan.
An important part of the assessment for this dimension is to establish whether there is any aspect of your mental health that could negatively impact your day-to-day functioning.
This includes your ability to demonstrate adequate levels of self-care. You may be identified as high risk if it appears you have:
- Neglected their own personal hygiene
- Your own personal needs
- Have been unable to hold down a job
- Cannot maintain positive relationships
Another critical area to be considered is whether you are a suicide risk or you are vulnerable to self-harm.
Dimension 4 – Readiness to change
In this dimension, the aim is to identify how ready you are to change and whether you are seen to possess the necessary motivation to fully engage with treatment.
It could be that you may not think that you have a problem.
It is important to evaluate if you are fully aware of your substance misuse behavior and the consequences that it has had for you.
To be ready to change and engage with the treatment you should be able to reflect on and accept your situation, realizing that you need to change in order to lead a more fulfilling life.
A low-risk rating in this area would exhibit a high level of motivation reflected in your regular attendance at relevant appointments.
It would also indicate that you are actively involved in, and committed to, following your own treatment plan.
The counselor will look for evidence that you are talking about making positive progress in key areas of your life, such as:
- Making progress in your employment, or
- Finding employment
- Studying for a new career
- Improving their physical health
- Improving the quality of your relationship with your family.
If it seems apparent to the counselor that you feel like you are being pressured into treatment and are only there because you must be, then this could be a red flag for a higher risk rating. Caveat: Be sure you want to get help. Identify the pros and cons of what is going on in your life.
Dimension 5 – Relapse, continued use, or continued problem potential
The pressing concern here is whether or not you are vulnerable in the short term to continue taking substances and experiencing any mental distress.
The risk rating attributed to this dimension needs to reflect how much of a relapse risk you have.
The risk rating will be high for this dimension if it is judged that not engaging with treatment may lead to a severe risk of relapse and high levels of distress.
The counselor will be required to identify if you have developed the psychological coping skills to successfully manage:
- Negative thoughts and emotions,
- Social pressures,
A person who is able to reflect upon what their triggers for relapse might be and has strategies to implement when such triggers appear would receive a lower risk rating.
Someone who is still unable to resist any impulses may be seen as a greater risk and in need of improving their cognitive skills.
Another aspect to investigate is how compliant you have been with adhering to any medication you have been prescribed for any mental health conditions.
An inability to do so could indicate a higher vulnerability to relapsing.
Dimension 6 – Recovery/living environment
Dimension 6 relates to the social element of your life.
ASAM criteria deem it important to investigate whether any aspect of your social environment may derail your attempt to engage with treatment.
- Your living circumstances
- Your work situation
- Any social and legal issues in their lives
- Quality of relationships or family issues
If there is a lot of discord prevalent with family members, or if you are leading a chaotic life with no fixed address, then the assessor may allocate a high-risk rating.
If, however, you are surrounded by supportive and caring family and friends, this would be seen as a positive resource in your recovery and you would receive a lower risk score.
Your work situation also comes under scrutiny as it is potentially a high source of stress.
Whether it is because of difficult relationships with colleagues, fear of redundancies, changes to work patterns, or tight deadlines, many people take substances to cope with the stress of work.
It is important to establish whether your workplace is a significant risk factor for having a negative impact on their well-being.
Assessing your financial situation is also an important consideration. Finance and debt are frequent causes of stress and worry for most people.
Debt could also be linked to other stressors in your life, such as homelessness or unemployment.
The counselor would be keen to note if there are any legal disputes affecting your ability to focus on your recovery, this may include:
- A custody rights battle,
- A criminal record complicating the search for work
- If you are currently facing criminal proceedings
If, however, you need to demonstrate significant improvements in your life in order to see your children, then this could provide the necessary motivation for you to fully engage with treatment.
All this being said, I hope this helps you understand how very important it is to engage with a treatment facility that cares enough to identify all these factors that go into the development of an Individual Treatment Plan that is designed specifically for you.
See the next blog post which will help you understand how this evaluation leads to where you are placed, and what level of rehab is best for you.