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The Practitioner Conection |
The right help at the right time!EAP SUBSTANCE ABUSE ASSESSMENT AND MANAGEMENT REFERRALSEffective assessment in determining the impact of chemical and alcohol use on your referred client can be developed as long as you are willing to be thorough and persistent. Clarifying your client’s consistency or evasiveness will involve creatively “re-asking” some of the same questions repeatedly throughout the evaluation. The pervasive symptoms of substance use literally require that the “user” ignore the progressive build up of the extent of how chemical use is impacting daily living (“denial” or “minimization”). Keep in mind that the substance abuser will tend to under-report, so your assessment needs to show that you looked at many aspects of the addictive process. Use Pattern: Find out all substances used and establish patterns of current use. How often, how much and how long has the individual been consuming? Getting a range of use is critical. Example: “When you drink, how many will you have: at least ____ , but if you really have a lot that would be up to _____?” Push the point and inquire: “And when you are totally ‘wasted’, how much did that take?” Discovering this “range” will indicate if your client has had heavier use. Find out how often in a week or month that greater use occurs. Also, gather a brief summary of your client’s chemical use history (age of first use and patterns of past chemical use.) Defensiveness: Seeking to look “good” or like a “normal” substance consumer, the individual may compare his or her consumption to heavier users. Find out what percent of the client’s social network are also substance abusers as that will help determine how much reinforcement and access to the chemical use remains. Inquire if anyone is expressing concerns about use including spouse, friends, family, employer, or children. Ask about remorse from chemical use: “Have you ever said or done anything while you were drinking/drugging that you regretted afterward?” Get details of exactly what your client would like to have done differently. ** If at all possible seek collateral contact from family, friends. The Employee Assistance Consultant working with you on an EAP management referral may have observations from the workplace on behaviors, work quality, absenteeism, etc. Let your client know that you aren’t so much doubting their own report, but that getting a thorough perspective is an industry standard of a substance use-focused evaluation. It’s even likely other significant people in his/her life don’t know about the employer’s initiative to make an EAP referral. If the individual refuses collateral contact, you could inform them that your recommendations may include a higher level of education or treatment since you had limited information from their self-report only. Progressive symptoms: Did substance use continue despite negative life consequences? For example, were there any threats of job or relationship loss, legal consequences or a positive use test, and yet the individual consumed the chemical again? When looking at continued use, this indicates clinical concerns such as “cravings” or “compulsive use”. The substance use does not make rational sense, but the user “keeps on using”. Explore any tolerance symptoms: The use pattern inevitably increases, so look at recent changes. Find out if the individual has ever consumed more of the chemical than he/she intended. A self-imposed “limit” indicates some self-awareness that a problem likely does exist. The range of amount consumed noted above has likely changed, and so try to find out how this looks different compared to past use history (showing periods where other substances were used including frequency and amounts.) Try to identify the ounces of alcohol consumed by considering the strength of the drinks served (alcohol content in beer, number of shots in each drink, etc.) Be sure to detail legal offenses (DUI or possession charges), as well as loss of jobs or relationships due to substance use. Attempts to control: Promises to self or others to stop or limit chemical use indicates that problems have developed directly from the drinking/drugging. If the individual “swears off” or agrees to stop all use for a space of time, this is focused directly at the negative impact that a progressive addiction has been taking. Look for: limiting of use, switching to only certain types of alcohol, more acceptable days/times or settings to get intoxicated (e.g. to reduce work absenteeism or danger on the job from being “under the influence”). Recommendations: When an individual presents for an evaluation following violation of a Drug-Free Workplace (DFWP) policy, a recommendation of some sort should be made. An employer referral to EAP does not necessarily mean the client wants to follow your recommendations. EAP and the employer are looking to your clinical expertise and recommendations post-assessment, not the individual’s preference or motivation level. Do not just take an individual’s “promise to never use again”. Your focus is on supporting what the individual needs to do to prevent continued or future issues regarding substance use in violation of DFWP policies. Your recommendation must respond to the concern that brought the individual to your assessment. Do not rely on the prospect of follow-up testing by the employer as sufficient support for the client to remain drug-free. Another test positive could lead to termination of employment. An outcome of a substance abuse assessment may range from a recommendation of further education, to individual counseling or IOP (Intensive Outpatient) treatment, as well as residential services and detox. A simple referral to a medical setting for observation will clarify if there is the need for a detox protocol. A very effective mode of care is Intensive Outpatient treatment (IOP). Consider this level of care for even “marginal” clients who may appear to not need significant intervention. This modality includes multiple groups and educational sessions each week and will often span 4-8 weeks of the intensive mode of treatment. Establishing a new set of places and people in the client’s life is the “gap” that needs to be corrected so substance-free living can be established. Since the IOP meetings can normally be coordinated apart from normal life routines (e.g. work schedules), this mode of treatment is very effective to keep the focus and support on recovery “long enough and strong enough” to really engage a lifestyle change. Education: If the assessment does not indicate a need for a referral to a formal, structured, treatment program, a recommendation for substance abuse education should be made. This can be accomplished through local community resources or education provided by the EAP provider in the remaining EAP sessions. This offers some preparation for the client to consider the costs of substance use and how to reduce the risks of relapse. This could be described as putting “tools in their tool kit” on how to face potential addiction issues rather than perpetuating problems that may lead to even more serious consequences. Given sufficient time and skill building, an educational series can also function as an extended assessment to determine whether the client has greater needs that could result in a treatment referral. Additional information on this topic can be found in our clinical library by clicking on the “Providers” link at www.cignabehavioral.com. Resources for members, including a Self Assessment and other educational materials, can be found by following the “Members” link and then clicking on “Information on Alcohol and Substance Abuse”. Other Featured Articles:KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS GAPS IN CARE FOR BIPOLAR DISORDER
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