The number of individuals depending on the intake of different substances grows exponentially. Up-to-date medicine struggles between treating humans’ bodies and spirit as sometimes spending more attention to the first aspect lead to an increase in humans’ addictions. By people’s nature, it is challenging to fight the feelings of craving and dependence, and several strategies and approaches should be united altogether to solve the problem and help the person recover from the abuse condition. Such help can ameliorate the condition and efficiency of the clients and lead to substantial improvements in the labor force and national productivity.
Drug and alcohol abuse has especially become a severe problem of the nation. Some researchers call the current situation with abuse in the United States a “drug and alcohol abuse crisis” (Grim, B. J. & Grim, M. E., 2019). Indeed, among humans aged more than 12 years, 165.4 million people used a substance over the past month, according to the 2019 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2020). Addiction to a substance not only deteriorates the life quality of people but also leads to early deaths and health complications. As a result, health service institutions spend more resources on support, treatment, and rehabilitation of addicted individuals. Proper assessment of humans with substance abuse by various professionals, including social worker specialists, can help improve the current statistics and help the majority of dependent humans.
DSM V Criteria
Substance abuse is not considered a disorder if it does not cause clinical or functional harm, for instance, health issues, disabilities, and irresponsible attitudes at work, school, or to other people. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a tool proposed by American Psychiatric Association regarding mental health disorders (Gateway Foundation, 2021). The DSM criteria for substance abuse can be into four categories – impaired control, physical dependence, social problems, and risky use (Gateway Foundation, 2021). Uncontrolled intake of substances, periods of cravings, preferring the substance use to the relationship with family and relatives, and putting at risk one’s life or condition because of the substance intake are meanings of major categories mentioned above.
To be more specific, DSM has eleven criteria that particularly refer to substance abuse patients. They involve the following:
- Using a higher dose of a substance than prescribed or using it for a longer period than it was indicated
- Having struggles with stopping the usage of substance
- Experiencing strong cravings or urges to use the substance
- Needing higher concentration of the substance to reach the wanted effect (in other words, developing a tolerance)
- Having withdrawal symptoms without substance intake
- Spending more time getting and using drugs and recovering from the use
- Neglecting any responsibilities at home, work, or school because of the usage
- Continuing to use the substance despite its causing the relationship issues
- Giving up significant or desirable social and free-time activities due to substance use
- Using substances in risky circumstances that might lead to danger
- Continuing to use the substance despite the damage to physical and mental health
The misuse of substances deteriorates within time, and DSM V criteria also allow to assess the severity of addiction gathering data from the patient. For instance, if the client has one out of eleven indicators, it signalizes the risk of developing dependence. Mild substance use disorder can be expected with two or three points mentioned above. Four to five criteria mean the moderate severity of substance use disease. Finally, six or more criteria indicate a severe state of the disorder.
Assessment
Social work professional aims to provide the best service and help the client unite and coordinate various professions and organizations. To achieve that goal, the social worker needs to succeed in proper assessment of the patient to understand the roots of his problems and attract professionals that are most useful on this occasion. Assessment is used to highlight the desirable and needed health and social care services to manage risk, organization of adequate communication between the professionals, and track the improvements of the client (Taylor, 2012). For the assessment of clients with substance abuse disorders, it is essential to gather data from various sources as well as build a close, trustworthy connection with a client.
Based on the DSM V criteria, the client should be asked what substance he is abusing, how long ago it started, and how often and in what dosage the intake is now. These initial questions can help border the circle of the issue and define the history of the disorder. Afterward, if the substance is not illicit and can be prescribed by a doctor, for example, opioid analgetic, the patient should answer the question if he goes to the physician to get the substance to further misuse it. Misusing is a way to take the drug, breaking the prescribed rules for a longer period or with increased doses. The client should also try to estimate the level of addiction to the substance – if he struggles to stop the substance intake and if there are cravings in periods without the substance.
The patient might also admit that he started increasing doses of a substance to reach the desired effect, that he has withdrawal conditions after the usage, and that it takes more time to use the substance and recover from this usage. Questions regarding social interactions will involve the responsibility issues and whether the client refrains from them. Additionally, if the client knows that substance use has deteriorated the relationship with people that are close and dear to him, he should be asked if he ignored those facts and kept using the substance. This question might not be easy to answer as it demands high responsibility and self-acceptance levels from the client. Not all individuals have these features, even in a healthy state and without addictions, that is why social work professionals should not expect an honest answer to the questions.
Another essential feature of the social connections of the client is his involvement in community and recreational activities or some activities he used to like before substance intake. If the client admits, he prefers substance to social activities, that indicates a serious social interaction impairment. The latter questions based on DSM criteria of substance abuse disorders refer to self-harmful behavior or self-mutilation. If the client knows about the possible risk the substance can lead to or about serious health damages and he keeps using the substance, these actions can be estimated as self-mutilation behavior.
However, as mentioned before, the client cannot provide a clear picture of the severity of the pathology because of his subjectiveness. Being on some stage of developing an addiction, self-perception tends to worsen and distort the actual flow of events. Moreover, the patient might not notice the deterioration of social connections with family members because of his focus on substance usage. That is why the social worker should ask the client’s permission to interview other close people in his life. The professional should show empathy and advocacy to the client so he understands that the social worker is aiming to help and work on his side. It is essential to express the positive intentions to help the patient and receive his agreement to interview other people in his life. Additional data gathering can help draw a true picture of the severity of the client’s condition and develop the program most efficient for him.
Theoretical Perspective
Usage of theories is central in the practice of any social worker as the theories allow to explore the true origins of the client’s conduct with the help of evidence-based approaches. The evidence-based assessment also allows uniting all the needed services from different professionals, the work of which together can promote social, emotional, and behavioral health to the client (Andrews et al., 2020). With substance abuse clients, the person-in-environment approach can explain their behavior through their surroundings. The patient’s environment, together with his experience and upbringing, shapes the specialties of his subjective perception of the world. The person-in-environment approach allows looking at the client’s problems wider, from a macro approach, abstract from his personalia, mental health disorders, and addictions. The questions a client will be asked in the framework of this approach are:
- Can you describe the relationship with your mother and father?
- Did your parents or anyone in the family have any addictions or mental health issues?
- In your childhood, did you feel love and care from family members?
- Do you remember if any of your parents or family members taught you to get a reward after achieving the goal?
- What do you feel when you use a substance? Does it seem as you replace the lack of love and care from family members with this action?
- What neighborhood did you grow up in? Was it much crime there?
- If yes, did you get along with peers in your neighborhood?
- Do you still have friends from childhood that have issues with law or substance use?
- How many people surround you with substance abuse currently?
- Do you feel as except for substance abuse, you have a lot in common with these friends?
The question can identify the possible roots of the issue coming from the client’s childhood, relationship with family, and current connections with influence groups.
Client Self-Screening Tools
The Rapid Alcohol Problems Screen (RAPS4) is a four-item screening instrument that is shaped to detect alcohol addiction in emergency room patients that have confirmed diagnosis according to diagnostic criteria. It is an oral test that takes around two minutes, and the results are calculated by hand (Substance Abuse and Mental Health Services Administration, 2022). The test has no norms available or computerized scoring. The test can be presented to a client by explaining the importance of understanding his issues better by social work professionals. The latter also can clarify that the client can trust the social worker and be honest whilst answering the questions as the results will stay between them.
The social worker assesses the results by self, and that can be an advantage and disadvantage at the same time. According to various research, the RASP4 is a more effective way to identify alcohol dependence than other tests such as CAGE, AUDIT, Brief-MAST, and TWEAK (Substance Abuse and Mental Health Services Administration, 2022). The other studies have proven the effectiveness of the test (Hodge, 2005; Petersen et al., 2019). Thus, the method can be used to detect alcohol dependence by experienced social work professionals and provide reliable data.
References
Andrews, J. H., Cho, E., Tugendrajch, S. K., Marriott, B. R., & Hawley, K. M. (2020). Mental health problems: A practical guide for school settings. Children & School, 42(1), 41-52. Web.
Gateway Foundation. (2021). DSM-5 criteria for substance use disorders. Web.
Grim, B. J. & Grim, M. E. (2019). Belief, behavior, and belonging: How faith is indispensable in preventing and recovering from substance abuse. Journal of Religion and Health, 58, 1713-1750. Web.
Hodge, D. R. (2005). Developing a spiritual assessment toolbox: A discussion of the strengths and limitations of five different methods. Health & Social Work, 30(4), 314-323.
Petersen W., P., Morojele, N., Londani, M., Harker Burnhams, N., & Parry, C. D. H. (2019). Alcohol advertising, affordability, and availability, and the effect on adult heavy drinking and symptoms of alcohol problems: International alcohol control study (South Africa). Substance Use & Misuse, 54(11), 1751–1762. Web.
Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Web.
Substance Abuse and Mental Health Services Administration. (n.d.). Appendix D. Examples of screening and assessment tools for substance use disorders. Web.
Taylor, B. J. (2012). Developing an integrated assessment tool for the health and social care of older people. British Journal of Social Work, 42, 1293-1314. Web.