Evaluation of Addiction

The assessment must begin with a clinical history and a history of addiction.

In addition to the exploration of awareness of consumption discussed at the beginning of the module, it is necessary to understand the toxicological history and the evolution of consumption (e.g. age of onset, chronological evolution, motivations for consumption, context in which they occur, periods and doses of maximum or minimum consumption, the reason for the change of substance, among others) (Dirks, Scherbaum, Kis, & Mette, 2017).

After this analysis, they should be asked which is the main psychoactive substance (“drug of choice”) that prompted them to seek treatment, and they should assess their pattern of consumption over the last month. In this assessment, it is also necessary to take into account the use of addictive psychoactive substances obtained through medical prescription (e.g. benzodiazepines, opioids). To establish the severity of the dependency and, consequently, carry out the therapeutic plan, it is necessary to understand the pattern of consumption – frequency, dosage, and time(s) of day. Due to the lack of criticism and/or identification of the need for treatment, the amount reported may be lower than the real amount. Most of the time it can be difficult to quantify actual consumption, so the amount of money spent on consumption and the way it is obtained can be questioned (Gonçalves, Romão and Ismail, 2022).

It is also important to consider the presence of precipitating factors, to assess the circumstances in which consumption occurs (e.g. alone or in a group; in a private setting or in public places) and whether this is habitual behavior or limited to certain activities/moments.

Concerning the person’s overall functioning, it is important to assess the impact of consumption on the different dimensions of life and daily activities, on the economic and occupational situation and the existence of legal problems (Gonçalves, Romão and Ismail, 2022).

Evaluating the family history can give us important indications about the characteristics of interpersonal relationships with the different elements of the family, as well as identifying elements that may be available to get involved in the therapeutic process.

Below are some of the biological, psychological and social factors that influence addiction.

Biological factors:

Genetic predisposition: genetic factors play a significant role in susceptibility to addiction. People with a family history of substance use disorders may have a higher risk.

Psychological factors:

Mental health problems: Concomitant mental health conditions, such as depression, anxiety or trauma-related disorders, commonly coexist with substance use disorders.

Psychological vulnerability: Factors such as stress, trauma, low self-esteem and maladaptive coping mechanisms can contribute to the development and maintenance of addiction.

Social Factors :

Peer influence: Social networks and peer relationships have a significant impact on drug use behavior. Peer pressure, social norms and social support can influence the initiation and maintenance of substance use.

Socio-economic status: Socio-economic factors, including poverty, unemployment and lack of access to resources, can contribute to substance use and dependence.

2. Impact of Co-Occurring Disorders and Dual Diagnosis

The occurrence of comorbidities is very common in people who use drugs.

Therefore, during the evaluation process, it is necessary to identify its existence, which can be of two types:

• non-psychiatric medical comorbidities: these are very common and should be assessed at the time of the interview and complemented with full physical examinations and/or complementary diagnostic tests. The most prevalent infectious diseases in this population should be considered, such as hepatitis B and C viruses, acquired immunodeficiency virus, other sexually transmitted diseases and tuberculosis (Gonçalves, Romão & Ismail, 2023).
• psychiatric medical comorbidities (dual diagnoses): co-occurrence of a substance use disorder and another mental illness.  Several epidemiological studies point to the high prevalence of these comorbidities, with a predominance of Personality Disorders, Mood Disorders (e.g. Major Depression, Bipolar Disorder) and Psychotic Disorders. Substance use can lead to the onset of psychiatric symptoms, as can substance use to relieve psychiatric symptoms.
  
  
  

3. Considerations for Assessing Vulnerable Populations

Young People – Teenagers

Adolescence is a period of learning and change, both physical and psychological. It can be a phase of fragility and prone to the appearance of risky behaviors that sometimes represent forms of expression of discomfort. On the other hand, it is a phase of life in which there are many other risk factors, such as peer pressure and impulsiveness.

The assessment of this group must take into account the stage of development the person is at, namely their physical development:

• cognitive development: being able to analyze situations, use symbols, metaphors or images, imagine the future, define personal goals and evaluate different alternatives. On the other hand, at this stage when greater autonomy is being sought, there may be a greater need to argue for the sake of arguing, jump to conclusions and adopt a more egocentric stance. Adolescents need to see professionals as a help and not as a threat to their independence.
• emotional development: the acquisition of one’s own identity and the relationship with others; stress and emotion management. There is often a link between substance abuse and emotional regulation in this age group. Substances often mask problems, which are often painful and difficult to deal with in a clinical context (Reynaud, 2008).
  
  

It is also important to assess the family dynamics and the relationships that adolescents establish with other peers and adults.

Pregnant Women

Prenatal substance use can have several harmful consequences for both mother and baby. The substance used, the degree of use and the level of exposure all influence the effects of substance use in pregnancy. In addition to the direct effects of drug exposure in utero, several other variables are associated with adverse consequences for mother and baby, including psychiatric comorbidity, multiple substance use, limited prenatal care and interrupted parental care. Taken together, these factors can negatively influence the pregnancy and the baby and should be taken into account in the assessment carried out. Many of the health problems associated with prenatal substance use could be avoided with effective and timely medical care or interventions (Forray, 2016).

Concern about the impact of the substance on the developing fetus may motivate some women to reduce their use of drugs and alcohol during pregnancy.

The assessment should consider screening for the substance used, prenatal care and referral to a specialized treatment program.

LGBTIQ+ Individuals

LGBTIQ+ people face unique challenges related to stigma and discrimination, which in themselves can contribute to substance use as a coping mechanism.

The assessment must be carried out in a culturally competent and sensitive manner. Professionals should never assume the sexual orientation and/or gender identity of the person they are assessing, as this can make the person feel misunderstood and/or insecure, which can exacerbate the addiction problem. Inclusive language should be used and questions about sexual orientation, gender identity and support networks should be addressed.  It is also important that the professional does not make assumptions and/or comments about the sexual experiences and/or gender expression of LGBTQ+ people (Godwin, 2022).