Recently, I was in contact with Michael Salas, a licensed counselor. He had read my article, Substance Abuse Evaluations (SASSI) in DWI cases, which is one of the highest read pages from my blog.
He wrote an article about the other side of substance abuse evaluations — they way they should be done. Objective Substance Abuse Evaluations is the title and I’ve included the text below:
Objective Substance Abuse Evaluations
I recently read something on a local attorney’s blog that was disturbing to me. This was that some counselors who were evaluating clients were making recommendations based on one screening instrument alone. Thus, I thought it was important for me to write about completing a comprehensive substance abuse interview, evaluation, and report. Making an objective assessment on a person you spend an hour or two with is a difficult task, and I do not pretend to get to know the whole person in that timeframe. Also, I take care not to diagnose something that I am not sure of, because like it or not, a diagnosis is a label. I understand the need in our current state of counseling to have labels, but it is a label nevertheless. I would not want a label that I did not think was attributed to me, and I would not expect that a client would want an inappropriate label either.
There are ways for you to be sure that you are having an objective substance abuse evaluation completed. For an objective assessment and evaluation to be completed, you should be completing a fair amount of paperwork prior to the evaluation. I tell clients to expect to spend about an hour completing preliminary paperwork for the evaluation, and then another hour interviewing with me after this. The evaluation should be comprehensive, in my opinion, and not only focusing on your alcohol or drug use history. Ask if the format that is used is comprehensive. Two well known formats for this interview process are the ASI for adults and CASI for adolescents. The reason that you want the assessment to be comprehensive is because you can then take greater comfort in that the counselor is likely trying to see the whole picture and is less likely to jump to conclusions based on your alcohol and drug use history alone.
It is also beneficial to ask if the interviewer is using a computer-based report writing system. Using a computer-based system should not disqualify or deter you from having your evaluation completed by that person, but it does cue you to ask a couple more questions. If they use a computer based system, do they edit the automatically generated report? I have used computer-generated reports, but they should only be used as a skeleton. Those reports alone are incomplete at best. I have yet to complete an evaluation that was generated by these report-writing systems that did not need some editing to accurately reflect the person and his/her situation. It is also beneficial to ask if there are any other sources of information that will be included in the report. For example, it is my policy to ask for at least two collateral contacts to put into the report, include several screening instruments into the report, and to include barriers to treatment recommendations for clients as needed.
Over time, I have found that some clients are worried that a counselor is simply recommending something so that they can get the business themselves. This is an understandable concern. This is when it is important to understand the rational behind the recommendations. For example, at the end of an evaluation, I will tell a client of a range of what I will recommend for treatment. I give this range, because I have found in the past that if I give a specific recommendation at that time, and then contact collateral contacts and obtain new information, and the recommendation changes, the client is confused, upset, or feels lied to. At this time, I explain rationale for decisions being made. If a client has been in treatment recently, then that same level of care is less likely to be recommended. If a client has participated in several groups, and is again having troubles, then individual treatment is maybe more appropriate. If there have been multiple failed attempts of having no problems in an outpatient setting, then residential treatment may be necessary. There are many situations and scenarios that can make up a recommendation on an evaluation. One widely recognized recommendation determination tool is using ASAM ratings. This helps a counselor determine, which client is appropriate for which setting. But even this is not an end-all solution to making an appropriate recommendation.
Finally, the best recommendation I can give you is be open and honest. Sometimes people are honest, but not necessarily open. For example, if you go to the doctor and your knee has really been bothering you, but you are not in a place where you are wanting surgery or to be unable to work, you might not tell the doctor all of the information in hopes that this will change the recommendation. The only problem is that you are more likely to get a higher level of care recommended if you are not open. It is much easier to write a recommendation for someone for the least restrictive setting if they are open in an interview.
As you can see by the above information, writing a recommendation for a client objectively is a difficult task. There are ways, though, to determine if a counselor is writing an objective report. By asking the counselor how comprehensive the report is, how they generate their reports, and how open they are with you about the recommendations, you will be able to take greater comfort in the fact that your evaluation is objectively written to best reflect your current situation and needs.