The document discusses the process of assessment for addiction counseling certification. It outlines 12 key steps in assessment, including engaging the client, screening for co-occurring disorders, determining diagnoses and level of care needs. It also discusses using multiple sources of information, standardized instruments and drug testing in assessment. Further, it covers assessing risk, including for intoxication, withdrawal, aggression and suicide. Common co-occurring mental health disorders are also outlined.

1. Assessment Review
for the Addiction Counselor
Certification Exam
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review
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2. 12 Assessment Steps
 Engage
 Get authorizations and gather information from collateral sources
 Screen for co-occurring disorders
 Determine the severity of mental and SUDs
 Determine appropriate level of care
 Determine diagnoses
 Determine disability and functional impairment
 Identify strengths and supports
 Identify cultural and linguistic needs and supports
 Identify additional problem areas (medical, housing, education…)
 Determine readiness for change
 Plan treatment
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3. Assessment
 Screening determines the possible presence.
 Assessment
 Is an ongoing process
 Determines the nature and severity
 Develops specific treatment recommendations
 Surveys client strengths and resources for addressing “life
problems.” (wrap-around)
 Substance Abuse Assessment Foci
 Historical and situational factors contributing to or
triggering use
 Patterns of use
 Common signs and symptoms
 Consequences of use
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4. Assessment
 Examines the context(s) in which the disorder(s)
manifest
 Explores reciprocal interactions of…
 Family/marital life
 Social support/interpersonal functioning
 Physical health needs
 Spirituality
 Employment
 Financial issues
 Legal issues
 Other issues which may impact treatment (transportation,
childcare)
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5. Assessment
 Explores reciprocal interactions cont…
 Gender, cultural, linguistic issues
 Readiness for change
 Relapse risk
 Recovery support
 Special life circumstances (single parent)
 Medical conditions
 Client centered—respecting
 The client’s perceptions of his problems
 Goals he wishes to accomplish
 Strengths he has
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6. Assessment Instruments
 Forms
 Standardized interviews
 Limits interviewer to a script
 Requires limited training
 Collects the same information on all clients
 Structured interviews
 Probing questions can be asked
 Requires additional training/knowledge
 Self-administered tests/questionnaires
 Require some motivation and reading ability on the client’s part
 Standardized instruments have:
 Reliability
 Validity information
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7. Assessments
 Sources of information (with written consent)
 Personal reports
 Family
 Other professionals/prior treatment experiences
 May be the most objective resource
 Employment history
 Criminal records
 Drug tests
 Collateral information gathered should be confirmed to
the extent possible
 Accurate assessment requires the coherent integration of
multiple sources of information to avoid under- or over-
estimation of the problem.
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 7

8. Drug Testing in SUD Treatment
 Drug testing is
 Part of the initial assessment
 Used to identify drugs to make most appropriate treatment
recommendations
 Screen to prevent adverse effects of prescribed medications
 Component of the treatment plan
 Way to monitor use of substance and compliance with
medications
 Method to assess efficacy of treatment
 Method to document abstinence for legal matters, disability,
custody etc.
 Drug testing cannot replace an assessment to
diagnose a substance use disorder.
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9. Drug Testing in SUD Treatment
 Drug Testing
 Can accurately reveal drugs in the system
 Time frame for detection is limited
 Dependable for identifying frequent users
 Less accurate for infrequent or binge users
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10. Types of Drug Tests
 Breathalizer (hours)
 Urine (up to a month)
 On-site
 Gas chromatograph
 Can produce false positives
 Saliva (past day)
 Sweat and hair
 drug use patterns over periods of time
 Cannot discriminate between recent and past drug use
 Not able to identify use within past 3-8 days
 Blood
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11. Risk Assessment
 One of the most important functions at both
screening and assessment
 Presence of any risk warning signs
 Requires immediate referral (detox, CST, ER)
 Screening and assessment are inappropriate
 Assess for:
 Intoxication
 Substance toxicity
 Withdrawal
 Aggression/danger to others
 Potential for self-harm or suicide
 Co-existing mental health issues
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12. Risk Assessment
 Signs of Drug Toxicity or Intoxication
 Nausea
 Vomiting
 Diarrhea
 Agitation
 Lethargy or stupor
 Increased or decreased heart rate
 Lack of coordination
 Slurring words
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13. Risk Assessment
 Signs of Violence
 Previous violence
 Young age at first incident
 Relationship instability
 Employment problems
 Substance use problems
 Major mental illness
 Personality traits that deviate from social norms
(exploitation, manipulation…)
 Early maladjustment or trauma
 Paranoia
 Failure to respond to treatment in the past
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14. Risk Assessment
 Suicidality
 Alcoholism (a factor in 30% of suicides)
 Psychiatric disorder
 90% of people who die by suicide have a mental health disorder
 60% of people who die by suicide have depression
 For alcoholics who are depressed the rate is 75%
 3 Domains for Assessment
 Current presentation of suicidality
 History
 Risk management
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15. Risk Assessment
 Signs of Suicidality
 Suicidal or self-harming thoughts, plans, behaviors or intent
 Specific methods identified
 Evidence of hopelessness, impulsiveness, panic attacks or
anxiety
 Lack of future plans
 Signs of “tying up loose ends.”
 Alcohol or other substance use
 Thoughts, plans or intentions of violence toward others
 Psychiatric illnesses
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16. Risk Assessment
 Signs of Suicidality
 Previous attempts or aborted attempts at suicide or self-
harm
 Family history of suicide attempts, suicide, mental illness,
addiction
 Acute psychosocial crises including financial or changes in
socioeconomic status
 Chronic psychosocial stressors including actual or perceived
interpersonal losses
 Family discord, domestic violence, current or pase sexual or
physical abuse
 Absence of external supports
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17. Mental Health Disorders Common in Co-D
 Borderline Personality Disorder
 Pervasive pattern of instability in personal
relationships, self image and affect in addition to
impulsivity.
 Antisocial Personality Disorder
 Pervasive disregard for and violation of the rights of
others
 Inability to form meaningful relationships
 Lack of empathy
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 17

18. Mental Health Disorders Common in Co-D
 Major Depressive Disorder
 Lack of pleasure in most things most days for at least 2
weeks
 Changes in sleep, appetite, energy, concentration
 Excessive feelings of worthlessness and/or guilt
 Suicidal ideation
 Bipolar Disorder
 Fluctuations between elation (mania) and depression
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 18

19. Mental Health Disorders Common in Co-D
 Anxiety Disorders
 Panic attack
Distinct period of intense fear usually peaking within 15
minutes
Significant fear-related physiological symptoms
 Panic disorder
Panic attacks + persistent fear of recurrence of attacks
 Obsessive Compulsive Disorder
Anxiety disorder involving obsessive thoughts which cause
anxiety and compulsive behaviors to address those
thoughts
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 19

20. Mental Health Disorders Common in Co-D
 Post Traumatic Stress Disorder
 Exposure to an stressor which involved the threat of death or
significant injury to self or another in which there was significant
helplessness and horror.
 Can occur when learning about a trauma which occurred to
someone else, especially a significant other
 Eating Disorders
 Person is intensely afraid of gaining weight and exhibits a
disturbance in the perception of the shape of size of his or her
body.
 Types
 Anorexia
 Bulimia
 Binge Eating Disorder
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 20

21. Mental Health Disorders Common in Co-D
 Schizophrenia and Psychotic Disorders
 Psychosis is the term for a severely incapacitated mental and
emotional state involving thinking, perception and emotional
control
 Hallucinations –False perceptions
 Delusions –False beliefs and a deterioration in thinking, judgement
or self-control
 Schizophrenia is the most common psychotic disorder
 NOT multiple personality
 Symptoms (often begin to develop before the first psychotic
episode)
 Hallucinations or delusions
 Disorganized speech
 Disorganized or catatonic behavior
 Deficits in functioning
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89
21

22. Summary
 Assessment is an indepth process that involves information
from the client and collateral sources to determine the
nature, course and severity of the issues
 Assessment is biopsychosocial in nature
 Assessment must take into consideration cultural factors
regarding having a mental illness, the participants in the
treatment process and who the decision makers are for
the client
 It is important to evaluate for multiple-occurring disorders
which may have overlapping symptoms.
 The assessment will guide placement and the
development of the treatment plan
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 22