1. CliniCal
Evaluation of
addiCtion
Dr. Ahmed Albehairy, M.D
Psychiatry Consultant
MOH

2. Clinical Evaluation Varies
??? Addiction Approaches

3. Clinical Diagnosis for discussion
internal medicine/ psychiatry /addiction
Mark degree of importance for each??
Provisional.
Etiological/ pathology.
Disease/syndrome.
Symptoms ?? Craving.
Psychodynamic mostly CBT.
Problems/ Complications
D.D.
Deferred and follow up of change base line.
Needs of the patient.

4. Core principles: Source of
information
Proper Clinical assessment process is important to generate a solidly
supported treatment plan.
- Clinical judgment.
- Patient’s self-report. ( individualize ttt , ttt goals are mutually
determined and targeted at real needs, enhance the pt”s
motivation).
- Collateral reports : family , as the pt is nt always willing , to
know how other perceive the problem, and to note whether the
pt had trouble with other intervention.

5. Goals of a Clinical Needs
Assessment
Beside providing the diagnosis for treatment of
substance use disorders,
Needs assessment process is essential:
1)Provide report for multiple service sectors.
2)Broad ranges of life areas.
3)identify,and response to co-occurring disorders,
and environmental or situational risk factors.

6. Goals of a Clinical Needs
.(Assessment (cont
4)identify, strengths, Psycho-Social-Spiritual supports,
personal resources and interpersonal resources.
5)Identify the patient’s involvement with other systems.
6)Identify possible barriers to treatment.
7)Provide base line for monitoring change in the
problems.
8)Support evidence based practice.
9)Good validity and reliability.
10)Adminstered and interpreted with cultural sensitivity.

7. Hallmarks of a Good Clinical
Assessment
 Informs the treatment plan.
 Cross-checks for inconsistencies in the patient’s
self-reported information.
 Help facilitate patient recall and give the patient
voice.

8. Using the Assessment for
Severity-Based Problem Prioritization
 Assessing recency, breadth and prevalence of
clinical problems.
 Using scale scores in assessment as measures of
problem severity.
 Treatment and problem history as an indicator
of severity.

9. Global Appraisal of Individual Needs
((GAIN
 LECTURE ABBASSIA MARCH2013ABBSIA 201
Needs.pdf

10. Structure of GAIN clinical scale

11. Addiction Severity Index
(severity and baseline follow up)
 General info
 Additional tests??
 Employment/support status.
 Alcohol/drug.
 Legal status.
 Family history.
 Family and social relationship.
 Psychiatric status.
 Severity profile .

12. Addiction Severity Index
Severity Rating for the Interviewer

13. Addiction Severity Index
Severity Rating for the patient

14. Problem Severity and Intervention History Grid

15. CB Approach, case formulation
 Relevant childhood data.
 Current life problem. Already investigated.
 Core beliefs ( unlovable or helpless).
 Conditional assumptions/beliefs/rules ( +ve or
–ve).
 Compensatory strategies. (compulsive,
inappropriate, energy depleting, not
balanced, usage of drug.)

16. CB Approach, case formulation
.((cont
 Vulnerable situations, cues. Internal –
external.
 Automatic thoughts (core- conditional – drug
related).
 Emotion associated with automatic thoughts .
 Behaviors ( drug seeking, irresponsible
activities, abuse others, avoidance.
 Integration of the above data .

19. Steps of change

20. MAC2- Questionnaire

22. Diagnosis and Classification
 Comparison of DSM-IV and ICD-10.
 Future consideration in diagnosis.DSM-5

23. TREATMENT PLANNING
 Acute alcohol or drug intoxication or withdrawel
potential.
 Biomedical condition and complications.
 Emotional, behavioral, cognitive conditions and
complications.
 Readiness to change.
 Relapse, continued use, and continued problem
potential.
 Recovery environment.