Authors: Rinaldo Minniti
Subject: Early Intervention Strategies, Drug & Alcohol
Type of resource: 0
Abstract: Assessment of substance use in persons with mental health problems poses major challenges to clinicians from both domains, given that assessment and management is complicated by their interaction. Assessment of substance use is often an extension of the assessment of mental health problems, usually on the basis of evidence of substance abuse or dependence, the aim being to determine the presence of either of these conditions. Research indicates that any level of substance use can be problematic for such patients.
Hypotheses regarding the relationship of substance use to mental health problems are commonly made, including the self-medication hypothesis, based on the separate assessments of substance use and mental health problems. Research indicates that such patients use substances for the same reasons as persons without mental health problems
An integrated, interactional, assessment procedure is presented based on Motivational Interviewing principles and techniques is presented. It is posited that this procedure will result in the patient being more open and honest in reporting their substance use pattern. This will also provide a clearer picture of the patient’s reality with regard to the relationship between their mental health problems, substance use, psychological and social functioning.
It is posited that the development of an understanding of the patient’s reality with regard to the relationship between their substance use, mental health problems, medication and day-to day functioning is more productive than objectively diagnosing substance abuse or dependence. Clinical research and experience indicates that this population uses alcohol and other drugs for similar reasons as persons without mental health problems although the self- medication hypothesis is often used to explain substance use, abuse and dependence.
An interactive process of assessment based on Motivational Interviewing is presented that facilitates an understanding of the patient’s reality with regard to the relationship between their substance use, mental health problems, medication and day to day functioning. Hypothetically, this will result in better rapport, openness, and motivation to seek treatment and enhance responsiveness to advice. This method of assessment is also posited to enhance the development of the “self” which has been shown to enhance overall recovery in persons with mental health problems. The assessment guide is based on the synthesis of clinical experience and published research.