PSYCHOLOGICAL ASSESSMENTS IN ALCOHOL AND DRUG ADDICTION
Introduction
People have the normal tendency to try things either out of curiosity or out of necessity. There is an inclination to engage in certain behaviors or indulge in certain substances to determine their effects on one’s life. Alcohol and drugs are two of the most common things that people use and often lead them to dependence. Alcohol and drugs are not detrimental by their nature. Both have normal effects when used appropriately. People take drugs, for instance, because of their physical effects (Marsden 2005) or to treat some physical illnesses. Alcohol is a normal indulgence during relaxation and leisure. Both substances when used accordingly actually make people better. The problem occurs when the people using them lose control and are overcome by their power.
Addiction in not merely the chronic use of something. Addiction rather involves compulsion, loss of control over the time and amount of the thing used, and continued use despite negative consequences. These consequences may range from impairment in physical, cognitive, psychological, emotional, social, and spiritual health (Landry 1994, p. 7). Drug addiction and alcoholism can begin with only a few “tries”. Depending on the “rush” or pleasurable sensation that happens to make a user tick, drug addiction and alcohol addiction over time is when the need for this sensation begins to consume a person’s mind, inhibits the ability to rationalize clearly, and becomes the very reason for which that person lives and thrives (Narconon Stone Hawk Rehabilitation Center 2006).
Alcohol and Drug Addiction
According to Addiction Intervention Resources Inc. (2006) addiction, drug addiction, alcoholism and chemical dependency are all common clinical vernacular for dependence upon alcohol, drugs or other harmful behaviors. The word “drug” is defined as “a chemical substance that affects the central nervous system, causing changes in behavior and often addiction.” The symptoms of addiction include an inability to stop drinking or using drugs despite physical, mental, family, social, financial, legal, or other consequences. Those who are addicted to drugs or alcohol exhibit a strong craving, loss of control, physical dependence and tolerance (Alcohol/Drug Council of North Carolina 2005).
It is essential to understand that when dealing with addicts, we are dealing with individuals whose brains have been altered by alcohol, drug or behavioral abuse. Thus, they need addiction treatment (Addiction Intervention Resources 2006). Treatment is the most effective way to help an addict begin the life long journey of recovery. It removes the sufferer from the environment where they used alcohol and/or drugs and surrounds them with others who suffer from the same problems. Time in treatment can be short or long, but it provides a solid foundation for the process of change to begin (Alcohol/Drug Council of North Carolina 2005).
The Treatment Method
Millions of Americans are apparently “hooked”, not only on heroin, morphine, amphetamines, tranquilizers and cocaine, but also nicotine, caffeine, alcohol, sugar, and steroids. There seems no end to their dependencies, their bewildering intractability, the glib explanations for their causes and even more glib solutions (Rodgers 1994, p.1).
Landry (1994) argued that the most effective treatment for alcoholism, and indeed for addiction to any psychoactive drug, combines early intervention, education, counseling, self-help programs, neuro-feedback, a healthy diet, and pharmacological adjuncts that improve nutrition, particularly brain nutrition (p. 313).
Moreover, there are different types of therapies that can support the treatment of the dependence. Cognitive behavioral therapy is a therapy in which a specially trained therapist tries to change the thoughts, feelings and conduct of the dependent person that lead to relapse, use or undesired behavior. The therapist also tries, together with the client, to teach certain behavior to prevent the person from relapsing: for example learning how to reject drinks or drugs that are being offered. The client learns how to deal with his intense need to use. The therapy also teaches clients how to deal with life without the dependence. Other forms of therapy are psychodynamic psychotherapy, group therapy, family therapy, and self-help groups. Since addicts often use drugs to suppress unpleasant feelings, one goal of therapy often is to teach people to learn to accept unpleasant feelings and to handle them in constructive ways (Moelker 2006).
The Role of Psychological Assessments in the Treatment Method
The recent news is that brain, mind, and behavior specialists are rethinking the whole notion of addiction. With help from neuroscience, molecular biology, pharmacology, psychology, and genetics, they're challenging their own hard-core assumptions and popular "certainties" and finding surprisingly common characteristics among addictions. They're using new imaging techniques to see how addiction looks and feels and where cravings "live" in the brain and mind (Rodgers 1994, p.1).
Once an alcohol or drug dependent agrees to undergo treatment, two programs are available for him or her. These are inpatient treatment or outpatient treatment. Inpatient treatment, or often referred to as primary treatment, takes place in an alcohol and drug unit of a general medical-surgical hospital or in a freestanding treatment facility. A good inpatient program uses a multifactorial approach of assessments which include medical, social and psychological assessments. Detailed psychological assessments which consist mostly of testing are done early in treatment. Two commonly used tests are the Minnesota Multiphasic Personality Inventory (MMPI) and the Shipley Institute of Living Scale (SILS) (Milhorn 1994, pp. 126-127).
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
The MMPI-2 instrument as reported by Butcher and Megargee (2006) is the most widely researched and widely used test of adult psychopathology to assist clinicians with the diagnosis of mental disorders and the selection of appropriate treatment methods. The test can be used to help assess major symptoms of social and personal maladjustment; give a strong empirical foundation for a clinician's expert testimony; assess medical patients and design effective treatment strategies; and evaluate participants in substance abuse programs and select appropriate treatment approaches. The MMPI has two sets of scales. The first set reflects the patient's degree of cooperation with the testing and indicates whether or not the other scale should be considered valid. The second set reflects his personal characteristics, as well as delusional, disorganized, or psychotic thinking (Milhorn 1994, pp. 126-127). The MMPI has ten clinical scales that are used to indicate different psychotic conditions. These scales are hypochondriasis, depression, hysteria, psychopathic deviate, masculinity/femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion (Van Wagner 2006).
According to A.S. (2006) the Addiction Acknowledgment Scale (AAS) is a Minnesota Multiphasic Personality Inventory (MMPI) subscale for assessing personality dimensions underlying the development of addictive disorders. It is a true/false questionnaire. It detects personality characteristics that are associated with developing alcohol abuse problems.
The Shipley Institute of Living Scale (SILS)
The SILS is used to estimate verbal intelligence quotient (IQ). It also estimates cognitive quotient (CQ), which is an indication of the patient's ability to think and reason. The verbal IQ is usually minimally affected by years of drug abuse, but the CQ may be depressed, indicating some degree of loss of brain functioning (Milhorn 1994, p. 127). CQ provides a measure of abstract ability, a skill that appears especially vulnerable to the effects of sustained abusive drinking (Campbell et. al 1999, p.1). Repeat testing in three to four weeks will determine if this loss of intellectual functioning is reversible or permanent (Milhorn 1994, p. 127).
Senior (2001) wrote that the SILS is a self-administered test and consists of two subtests. The first is the Vocabulary subtest of forty multiple choice questions in which the respondent is asked to choose which of four words is closest in meaning to a target word. This subtest relies on verbal skills which include reading ability, verbal comprehension, acquired knowledge, long-term memory, and concept formation. The second subtest in the Abstraction subtest of twenty questions in which sequences of numbers, letters, or words with the final element in each sequence omitted. The respondent is required to complete each of the sequences. The Abstraction subtest relies more heavily on attentional abilities, letter, word, and number concept formation, abstract thinking, cognitive flexibility, analysis and synthesis, processing speed, long-term memory, and specific vocabulary and arithmetic skills. Assessing a client’s abstract reasoning skills can assist with matching the client to a program with a strong cognitive -behavioral orientation (Salter 2005). SILS' use reflects the tests potential for detecting the presence of intellectual deterioration. Another role for which the SILS is commonly employed is the assessment of general intellectual ability (Senior 2001).
Other Psychological Assessments Used in Alcohol and Drug Addiction Treatment
The Addiction Severity Index (ASI)
The Addiction Severity Index (ASI) has also been used to predict the outcome of substance abuse treatment. The ASI, now in its fifth iteration, was commissioned by the National Institute on Drug Abuse, as a measure for the assessment of severity levels in the domains known to be affected by both alcohol and drug abuse. These domains are medical, employment, family/social, legal, and psychiatric/psychological (Craig and Olson 2004, pp.1,3). Each of these areas is examined individually by collecting information regarding the frequency, duration, and severity of symptoms of problems both historically over the course of the patient’s lifetime and more recently during the thirty days prior to the interview (Book Rags 2006). The higher the score on the ASI indicates a greater need for treatment in each of these areas. The ASI scores can be used to profile patients’ problem areas and then plan effective treatment (Gustafson 2005). The instrument also provides separate severity levels for both alcohol and drug abuse. Factor analysis of the ASI revealed that the test has four dimensions: labeled chemical dependence, criminality, psychological distress, and health-related problems. The ASI consists of approximately two hundred items and yields computer-generated, quantitative composite scores (CS) of problem severity ratings in each of the seven domains during the 30-day period prior to the interview for each of the domains. The ASI takes approximately 45 minutes to administer via the computer (Craig and Olson 2004, pp.1,3).
The ASI is particularly useful in the diagnosis and treatment of alcohol problems. It provides information on the frequency, duration, and intensity of alcohol and drug use. The ASI also examines psychosocial functioning which is crucial to understanding alcohol dependency. The ASI is a cost-effective alternative for the assessment of alcohol problems—when compared to the Structured Clinical Interview for DSM-III-R (SCID), a more formal and more expensive approach (Book Rags 2006).
Alcohol Use Inventory (AUI)
Alcohol Use Inventory (AUI) is a 147-item, paper-and-pencil, self-report instrument which reviews drinking practices and attitudes toward drinking. It produces sixteen-factor analytically derived primary scales, five secondary higher order scales, and a single third-order scale that is regarded as a general measure of alcoholism severity (Campbell et. al 1999). Horn, Wanberg and Foster (2006) stated that the AUI test can be used by psychologists, social workers, chemical dependency counselors, and physicians to help differentiate drinking styles and develop individual treatment plans; provide an objective assessment of alcohol-related problems; and identify treatment-relevant classification of alcohol abusers based on DSM-IV classifications. It provides a basis for describing different ways in which individuals use alcohol, the benefits they derive from such use, the negative consequences associated with its use, and the degree of concern individuals express about the use of alcohol and its consequences.
The Personality Assessment Inventory (PAI)
The Personality Assessment Inventory (PAI) is a recently developed multidimensional objective personality measure designed to assess psychological functioning across several different clinical domains. In addition to eleven clinical scales (most with subscales), it also contains four validity scales, two interpersonal scales, and five scales related to treatment and case management. Although it is a relatively new instrument, the PAI has generated considerable interest among psychologists, due in large part to the inventory’s general format and the rational-quantitative methods used to develop its scales. The PAI contains two scales, Alcohol Problems (ALQ) and Drug Problems (DRG) that are particularly relevant to the assessment of individuals who may misuse psychoactive substances. These scales are designed to measure the presence and severity of the core features of substance dependence (e.g., withdrawal symptoms, loss of control over drinking) and consequences often associated with such use (e.g., legal entanglements, interpersonal conflicts, family difficulties). Data presented in the PAI test manual indicate that the ALC and DRG scales have adequate reliability and validity. The PAI also contains a scale, Positive Impression (PIM), which is designed to detect the degree of positive impression management among examinees. Fals-Stewart, in a study in 1996, evaluated the ability of individuals with psychoactive substance use disorders to dissimulate successfully on the PAL. As expected, patients receiving treatment for drug abuse who were instructed to respond honestly had significantly higher scores on the DRG and ALC scales than (a) patients instructed to respond defensively, (b) respondents suspected of abusing psychoactive substances, referred for an evaluation by the criminal justice system, who had reasons to conceal their drug use, and (c) respondents from a non-substance-abusing control group (Fals-Stewart and Lucente 1997, pp. 455-456).
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