Posted: August 18th, 2022
Unit 2 – Individual Project
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Type: Individual Project
Unit: Diagnostic Criteria
Due Date: Sun,8/21/22
Grading Type: Numeric
Points Possible: 125
Points Earned: Points Earned not available
Deliverable Length: 4–6 pages (not including the cover and resource pages)
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You have been given the task of writing an ongoing article for the upcoming staff newsletter. You are researching and developing special treatments for the dual-diagnosed clients who you will be treating at your new facility. There are many combinations of this type of client. One example would be a client with alcoholism and a depressive disorder.
Your paper should include the following for this assignment:
Please submit your assignment.
For assistance with your assignment, please use your text, Web resources, and all course materials.
Individual Project Rubric
The Individual Project (IP) Grading Rubric is a scoring tool that represents the performance expectations for the IP. This Individual Project Grading Rubric is divided into components that provide a clear description of what should be included within each component of the IP. It’s the roadmap that can help you in the development of your IP.
|Expectation||Points Possible||Points Earned||Comments|
|Pick 1 combination of a dual diagnosis; discuss how this particular client’s needs will be met by the treatment.||25|
|Provide an introduction to the characteristics presented.||30|
|Detail the treatment plan steps with a description of how they will address the client’s needs.||30|
|Describe how the treatment plan would be discussed with the client and their family or significant others.||30|
|Professional Language: Assignment contains accurate grammar, spelling, and/or punctuation with few or no errors. (APA formatting is required or style specified in assignment).||10|
|Total Points Earned|
While there are many forms of dual diagnosis, the most common is substance abuse and mental illness. Many professionals in the therapeutic world believe that all substance abuse is related to mental illness. Many counselors in the field of addictions often take the opposite approach. They believe that substance abuse and dependence stands alone and if stabilized, then the any other symptoms would disappear. However, for a client to become dually diagnosed, both a mental illness and a substance abuse problem meeting the criteria in the DSM-IV-TR should be met. While it is best practice to determine whether the substance abuse preceded the mental illness or the mental illness preceded the substance abuse, many agencies are unable to take the time to get into these issues at the beginning of treatment.
The intake therapist relies on self-reporting of the client to make these assumptions. The reliability of the addict often comes into question. If the client is a poor historian with memory deficiencies, then this becomes an even more difficult task to accurately complete. This takes the resulting attitude in which you have coexisting conditions, and it does not matter which came first. However, to best treat a client, it is an important distinction. For example, if a person is using substances to medicate a mental illness, then focusing on treating the mental illness will help alleviate the need for substances.
If the person is an addict without a mental illness, then focusing on the substance abuse will alleviate the symptoms of mental illness that should dissipate once the client is clean and sober, thereby eliminating the need for medicating a mental illness component that does not clearly exist without the use of substances. The point is not to legally medicate a person who does not need it. The last thing that a substance abuser needs is to become dependent on yet another drug, legal or otherwise. Those with true mental disorders needing medication need to be on appropriate legal medication to ensure stability and decrease their risk of incarceration for self-medicating an illness that could easily be taken care of professionally. The purpose of treatment is always to assist the client in becoming independent, self-reliant, and productive members of society in which they can thrive, rather than just survive.
Two Schools of Thought
In the field addictions, there are two schools of thought regarding dual diagnosis. On one end, there are those who believe that all medications should be stopped unless they are for medical purposes, such as heart medicine, diabetes, and the like. This group takes the position that they are trading one addiction for another and that using legal drugs is just as dangerous to the health of the client as the illegal ones. Either way, the client is still using substances, and this will foster dependence. On the other end, is an acceptance that some people have more than one illness and that it is better to be on legal medications rather than self-medicating with illegal, uncontrolled substances. The reasoning behind this stems from seeking stability in a legal manner that will be less detrimental to the client. The risk of legal problems only exacerbates the problems and will spiral the client even deeper into the abyss of addictions rather than manage it through the appropriate, socially acceptable channels.
The development of an effective treatment plan is a thorough and complicated process. The treatment plan must be carefully constructed to select and implement the proper assessment and diagnostic measures. The primary objectives of these assessments are to determine risks and needs and to predict potential responses to the treatment.
Throughout the history of offender rehabilitation, penologists have used three general types of assessments: clinical assessments, actuarial assessments, and risk/needs assessments. These types of assessments may be used separately or in combination with each other. The use of these assessments depends on the institution and its particular views regarding offender rehabilitation.
The clinical assessment refers to traditional one-on-one contact between an offender and a treatment specialist. The clinical assessment is typically used within social services, hospitals, and community-based corrections. For example, a parole officer has just received a new ex-offender. To determine the risk level of the paroled offender, the officer must conduct a clinical assessment by either referring the offender to a qualified mental health professional (QMHP) or using what is referred to as the LSI-R diagnostic.
The actuarial assessment methods were first used within the insurance industry. It was adopted by corrections officials and offender rehabilitation experts because of its ability to determine probability and risk. The actuarial method is most commonly used in conjunction with the other two types of assessments because it lacks the ability to identify needs.
The risk/needs assessment is the most commonly used assessment type today within offender rehabilitation. This assessment type uses both clinical and actuarial methods for developing treatment plans, and there are several types of risk/needs assessments for different types of deviant behaviors. For example, sex offenders cannot be given a general risk/needs assessment because of their particular deviant behavior. Instead, the specialized risk/needs assessment will focus on their behavior and actions toward particular victims.
Types of Diagnostic Instruments
The two diagnostic instruments used within offender assessments are the offender assessment system (OASys) and level of service inventory-revised (LSI-R). The OASys is a new system used primarily in European countries, and it was adopted after corrections administrators decided not to use LSI-R. The following are the criminogenic needs areas covered on the OASys:
The LSI-R is an assessment instrument developed in Canada that focuses on static and dynamic factors. Static factors are unchangeable, such as age at offense, height, victim type, past criminal motivation, and biological traits. Dynamic factors are those that are linked to criminal behavior. The transition from experimenting with illegal drugs to using them more frequently is an example of a dynamic factor. The LSI-R is similar to the OASys assessment and is based on the following eight factors:
The development of a solid treatment plan must incorporate the results of a diagnostic test. One way to incorporate all of the necessary components is to compose the plan using the cycle of change. The cycle of change states that there are five stages of change:
Precontemplation refers to the offender who has a limited understanding of why he or she commits deviant acts. Contemplation moves into acknowledging that a problem exists and desiring to change one’s behavior. Determination creates a change strategy, which identifies problems, as well as an action plan to change behavior. Action refers to the individual steps taken by the person to follow the action plan and maintain good behavior. Maintenance refers to the person exhibiting good behavior but not being completely rehabilitated.
Diagnostic criteria for substance abuse and dual diagnosis can be intertwined. It is important to discover whether the dependency is based on a preexisting mental illness that the client was medicating or that the symptoms of mental illness are the result of the use and abuse of substances. The Diagnostic and Statistical Manual of Mental Disorders outlines both the criteria for various substance-abuse disorders as well as mental illnesses. It is important to remember that this manual is for use by professionals due to the many nuances and overlapping issues. According to the DSM-IV-TR, it was written more as a tool for professionals to be able to speak to each other about common symptoms and illnesses in their clients rather than a cut and dried format to place a client in a box. This is clear due to the many editions that have come out over the years including DSM-V, which is currently in the works. This work is evolving as we learn more about the human psyche. However, some might say it is becoming increasingly inclusive to the point that someday it may include most of the population. The most important thing to note here is that the degree of mental illness falls along the lines of impairment in functioning. This is a key issue. Although many would argue that this is not necessarily important due to the ability, for example, of the functioning alcoholic to fulfill daily obligations. It does fit in with the current understanding that total abstinence is not likely because use and abuse of substances has been around for a long time. This follows the thought that all we can hope for is a decrease in the harm it causes to individuals and society as a whole.
The Criteria for Substance Abuse
The following list includes substance-abuse disorders that are listed per the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000, pp. 15–22). The list specifies the disorders with physiological dependence/without physiological dependence:
The DSM-IV-TR uses the Axis system to present diagnostic findings through the use of criteria for each disorder discussed. Below is an example of the Axis system and what diagnostic elements are placed on each axis. Axis I reflects clinical issues. Substance-abuse disorders and clinical disorders are placed here. If there is not enough information but the clinician feels that it still needs to be looked at, then an R/O or rule out is put in front of the diagnosis in question. If the client presents with most of the criteria but falls short of a full diagnosis, you might put NOS or not otherwise specified following the diagnosis. If there is not enough information for either of these, then a V code can be used to distinguish this.
While Axis II is important and needs to be noted, most of the work is done in the clinical section. More specialized therapeutic interventions are needed to assist those with MR/DD and personality disorders. Some agencies zero in on these populations, whereas others do not have the resources to include them. For example, the Board of MR/DD might take care of the MR/DD aspect and send the client out for counseling for an Axis I issue such as depression or anxiety.
Personality disorders are more difficult to treat and take a specially trained staff to incorporate their treatment into ongoing care. For example, DBT is typically a good fit for BPD or borderline personality disorder. This is an intensive, yearlong program that needs specially trained staff. The ratio of staff to client is small and reimbursement may be too minimal to be cost effective for many agencies.
American Psychiatric Association (APA). (2000). DSM-IV-TR, diagnostic and statistical manual of mental disorders-text revision (4th ed.). Arlington, VA: Author.
|Offender Assessment Diagnostic Tools|
Level of service inventory-revised (LSI-R)
Offender assessment system (OASys)
|The LSI-R is an assessment instrument developed in Canada that focuses on static and dynamic factors. Static factors are factors that are unchangeable, such as age at offense, height, victim type, past criminal motivation, and biological traits. Dynamic factors are those that are linked to criminal behavior. The transition from experimenting with illegal drugs to using them more frequently is an example of a dynamic factor.||
The OASys is a relatively new system developed and used primarily in European countries. The system was adopted after corrections administrators decided to no longer use the LSI-R.
Training and employability
Financial management and income
Lifestyle and associates
Thinking and behavior
Question 1: What is the Diagnostic and Statistical Manual of Mental Disorders?
Answer 1: To better classify mental disorders, the Diagnostic and Statistical Manual of Mental Disorders has been the key resource for recognizing clinical abnormalities of personality or mental health. Originally, the United States developed the classification system with the need to collect statistical information on idiocy or insanity in the 1840s, and later to better classify the recognizable symptoms of men returning from World War II. Over time, seven categories were recognized, and what developed throughout its evolution was essentially a glossary of recognized mental disorders. It is in its 4th revision, and thus named the Diagnostic and Statistical Manual of Mental Disorders IV – Text Revision (DSM-IV-TR).
Although it is a useful tool in diagnosing patients, the American Psychiatric Association (2000) states that, “compelling literature documents that there is much ‘physical’ in ‘mental’ disorders and much ‘mental’ in ‘physical’ disorders… it must be admitted that no definition adequately specifies precise boundaries for the concept of ‘mental disorder.'”
Question 2: What are the most commonly explored disorders seen in most clinics and therapeutic environments?
Answer 2: The most commonly explored disorders as seen in most clinics and therapeutic environments are the following:
Question 3: How does the DSM determine and diagnose the type and longevity of a disorder (or multiple disorders) for a client?
Answer 3: The DSM utilizes five levels on a multiaxial assessment to determine and diagnose the type and longevity of a disorder, or multiple disorders for a client (American Psychiatric Association, 2000, pp. 27–34). They are as follows:
Question 4: What are common theoretical approaches to dealing with DSM disorders?
Answer 4: There are many theoretical approaches to the treatment of mental distress and disorder. Ultimately, each is based in specific theoretical beliefs systems about human development and how personality is formed. There are three core approaches: humanistic, behavioral, and psychoanalytic; however, in dealing with some mental disorders that are medical or biological in nature, drug therapy serves as an important part of treatment. Also, many family and relational therapists work from a systemic approach, recognizing that individuals are the result of a system of interaction and response, which impacts perception and beliefs. Therefore, it is helpful to suggest that in modern therapy, there is a foundation of core approaches with various theories, techniques, and methods.
Question 5: What is the psychoanalytic theory?
Answer 5: The psychoanalytic theory is a model of personality development and a method of psychotherapy originally outlined by Freud that focuses on the role of the unconscious on human development. It suggests that personality develops during the following five key stages from birth until later adulthood:
The evolution of other stage-related theories are based in psychoanalytic theory and continue to focus on early development in personality formation and mental disorders. For example, attachment theory is how we bond with our caretakers and early belief systems based on positive or negative learning at stages of development; Adlerian psychology focuses on birth order and social interests.
The usefulness of psychoanalytic theory in the treatment of mental disorders is limited to diagnosis on Axis I that pertain to belief systems and unconscious drives. Psychoanalysis seeks to move the unconscious to the conscious level and resolve early beliefs and issues surrounding the first few stages of life or placement within the family system. It includes, but is not limited to, brief psychodynamic therapy (treating selective disorders within a brief period of time), hypnosis, dream interpretation, free association, projective techniques (projecting a parent figure in order to handle feelings and thoughts), and awareness of placement within the family system and the roles and tasks associated with that placement.
Question 6: What is the analytic theory?
Answer 6: The analytic theory, developed by C.G. Jung, focuses on reintegration of the past with the present, bringing the conscious together with the unconscious, and individuation, that is, the process of becoming a distinct individual from the social collective. The significance of Jung’s work in today’s therapeutic efforts is from Jung’s Typology Test (later the Myers-Briggs Personality Assessment) which has been useful in organizing an array of sixteen distinct personality types. This has been practical in understanding career choices and fields of work that match personality and interests.
Question 7: What is behavior therapy?
Answer 7: Behavior therapy is a model that stems from experimental findings and research. It is based on principles of learning that are systematically applied, and all treatment is expected to be specific and measurable. It focuses primarily on the client’s current problems and strives to change maladaptive to adaptive behaviors largely through education and skill development. The premise of behavioral therapy and how humans function is that humans are determinists, that is, people who are controlled by their environment. Some of the key therapies emerging from behavior therapy are the following:
Behavioral therapy focuses on maladaptive behaviors and not on feelings. It has gotten criticism for ignoring relational factors and for being deficient in providing the client with insights about his or her behaviors through exploration of feelings. Behavioral therapy is useful in the treatment of mental disorders that involve specific behaviors such as substance abuse, addictive behaviors, anxiety, or depression.
Question 8: What is the humanistic theory?
Answer 8: The humanistic theory (or existential theory) is an approach that is philosophical in nature and focuses on the meaning of human existence. It works to explore an individual’s sense of value and meaning in life as well as exploring issues of love, death, and living. From humanism, the following theories or approaches have emerged that pertain to and value the individual (Messina & Messina, 2008):
Humanistic therapy emphasizes that humans are not prone to function under fixed laws or as gears in machinery, but rather, that they are entities that intend to do good unless thwarted by their experiences. This approach is particularly useful for other issues in the DSM such as relational, grief, academic, social, spiritual, acculturation, or occupational concerns and stressors (Messina & Messina, 2008).
Question 9: What is biomedical or drug therapy?
Answer 9: Biomedical or drug therapy often focuses on the treatment of psychological disorders through the combination of traditional mental health therapy and either drug therapy, electroconvulsive therapy, or psychosurgery. It is especially useful with Axis II personality disorders and mood or anxiety disorders. The following are several types of biomedical and drug therapies (Psychological Treatment, n.d.):
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Messina, J. J., & Messina, C. M. (2007). Theories of personality. Retrieved from http://www.coping.org/write/hs814person/content.htm
Spark Notes. (n.d.). Psychological treatment: Biological therapies. Retrieved from http://www.sparknotes.com/101/psychology/psychological_treatment/biomedical_therapies.html
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