presented by ashley cole, ma project link case manager region ten community services board p roject...

Presented byAshley Cole, MA

Project LINK Case ManagerRegion Ten Community Services

Board

PROJECT LINK TECHNIQUES & TOOLS FOR

SUBSTANCE ABUSE DETECTION

PROJECT LINKSUBSTANCE ABUSE Screening

Techniques

IN CONDUCTING A SCREENING, THE JOB OF THE INTERVIEWER IS NOT TO DIAGNOSE AN ADDICTION PROBLEM, BUT TO:

DETECT WARNING SIGNS

HELP THE CLIENT UNDERSTAND THE RISKS ASSOCIATED WITH DRUG USE

HELP CLIENTS ACCEPT FURTHER ASSISTANCE AS NECESSARY.

PROJECT LINK SUBSTANCE ABUSE Screening

Techniques(cont)

NOTE:

IT IS ESSENTIAL THAT THE CLIENT BE MADE TO FEEL AT EASE AND AS COMFORTABLE RESPONDING TO THE QUESTIONS AS POSSIBLE.

IT IS USEFUL TO BEGIN ASKING ABOUT TOBACCO AND ALCOHOL AND THEN PRESCRIPTION DRUGS BEFORE MOVING ON TO THE ILLICIT DRUGS.


Techniques(cont)

SOME GENERAL GUIDELINES FOR INITIATING A DISCUSSION ABOUT SUBSTANCE USE ARE:

DO SO ONLY IN THE CONTEXT OF A RELATIONSHIP BASED ON TRUST AND MUTUAL RESPECT.

MENTION THAT THE QUESTIONS ARE PART OF YOUR ROUTINE PROCEDURES.

ASSURE CONFIDENTIALITY. IT MAY BE HELPFUL TO MENTION THAT IN VIRGINIA THE

SOCIAL SERVICES POLICY IS NOT TO REMOVE A CHILD FROM THE HOME SOLELY BECAUSE OF ALCOHOL OR OTHER DRUG USE BY A PARENT.


Techniques(cont)

MAINTAIN A POSITIVE ATTITUDE AND A RELAXED COMPOSURE.

PROMOTE AN ATMOSPHERE OF COOPERATION.

BE ALERT TO CLUES IN A CLIENT’S PHYSICAL, SOCIAL, EMPLOYMENT, OR FAMILY LIFE. REMEMBER THAT THE USE OF ALCOHOL AND OTHER DRUGS OFTEN IMPACTS EVERY ASPECT OF A PERSON’S LIFE.

NOTICE CLIENT NONVERBAL CLUES:

AN INABILITY TO ESTABLISH AND MAINTAIN EYE CONTACT, STRAINED FACIAL EXPRESSIONS, DROOPED POSTURE, AND ANXIOUS AND JITTERY MOVEMENTS CAN PROVIDE YOU WITH INFORMATION ABOUT A CLIENT’S USE OF DRUGS


Techniques(cont) ASK THE QUESTIONS NON-JUDGMENTALLY.

BE SENSITIVE TO LEGAL IMPLICATIONS.

GIVE THE CLIENT TIME TO RESPOND AND TO ASK QUESTIONS OF HER OWN. REPEAT OR REPHRASE IF NECESSARY; SUGGEST A POTENTIAL RANGE OF ANSWERS.

ASK OPEN-ENDED QUESTIONS THAT DO NOT IMPLY ANY RIGHT ANSWER, OR GIVE AWAY YOUR OWN REACTIONS.

LET THE CLIENT KNOW THAT YOU APPRECIATE HER WILLINGNESS TO TAKE THE TIME TO RESPOND TO YOUR QUESTIONS.

BE ALERT TO SIGNS, SYMPTOMS, AND PATTERNS THAT ARE HIGHLY CORRELATED WITH SUBSTANCE ABUSE.

PROJECT LINKIndicators Correlated with Substance

Abuse

BEHAVIORAL

PHYSICAL

HISTORICAL

MEDICAL

PROJECT LINKBEHAVIORAL Indicators

HISTORY OF CHILD ABUSE AND/OR NEGLECT INCEST SURVIVOR HISTORY OF SUICIDE ATTEMPTS, THOUGHTS, OR

GESTURES CITATIONS FOR DRIVING UNDER THE INFLUENCE HISTORY OF DOMESTIC VIOLENCE CAR ACCIDENTS HISTORY OF SUBSTANCE ABUSE IN FAMILY DEPRESSION EATING DISORDER DIFFICULTY CONCENTRATING IRRITABILITY OR AGITATION INCONSISTENT STORIES


WEIGHT LOSS INAPPROPRIATE BEHAVIORSMELL OF ALCOHOL ON BREATH UNRELIABLE/UNPREDICTABLE BEHAVIORMISSED APPOINTMENTSSLURRED OR STAGGERED SPEECHFAMILY CHAOS HISTORY OF ABSENTEEISMCONFLICTS WITH SIGNIFICANT OTHERSONLY PRESENTS A VAGUE HISTORY OF

PERSONAL/MEDICAL PROBLEMSUNEMPLOYMENT OR UNDEREMPLOYMENT


UNSTABLE LIVING CONDITIONSERRATIC SCHOOL OR WORK HISTORYPARTNERS WHO HAVE SUBSTANCE ABUSE

PROBLEMS LACK OF PRENATAL CARE/MEDICAL CAREONE OR MORE CHILDREN WITH HISTORY OF

DEVELOPMENTAL, BEHAVIORAL, AND/OR EMOTIONAL PROBLEMS

CHILDREN IN FOSTER CARE SYSTEMPSYCHIATRIC TX AND/OR HOSPITAL

ADMISSIONS FOR PSYCHIATRIC DISORDERS INFANTS WITH LOW BIRTH WEIGHTS FREQUENT LAPSES OF MEMORYCHILD WHO DIED FROM SUDDEN INFANT

DEATH SYNDROME

PROJECT LINKPHYSICAL Indicators

BODY ODOR (ALCOHOL, CHEMICALS, POOR

HYGIENE)NASAL PROBLEMS (SNIFFLING, RUNNY NOSE)SKIN PALLORBURNED FINGERS (PARTICULARLY FINGERTIPS,

HANDS)BLOOD SPATTERS ON CLOTHING, FURNITURE,

ETC.EXCESSIVE USE OF EYE DROPSEXCESSIVE USE OF BREATH MINTS

BLOODSHOT OR GLASSY LOOKING EYESTEETH GRINDINGDILATED OR CONSTRUCTED PUPILSCUTS AND BRUISESDENTAL ISSUES/BAD BREATH

PROJECT LINKPHYSICAL Indicators

NAUSEA & VOMITINGSLURRED SPEECHLACK OF COORDINATIONLOSS OF MOTOR CONTROLNEEDLE MARKS DRY MOUTH (FREQUENTLY LICKING OF LIPS)MENTAL CONFUSIONDIZZINESSTREMORSUNKEMPT APPEARANCETARDIVE DYSKINESIA

PROJECT LINKHISTORICAL Indicators

ALCOHOL OR DRUG-USING PARTNERALCOHOL OR DRUG-USING FAMILY OF ORIGINMULTIPLE EMERGENCY ROOM VISITSHIGHER THAN USUAL NUMBER OF PHYSICIAN VISITSCHILD WITH ALCOHOL/DRUG-RELATED BIRTH

DEFECTS CHILD WITH HISTORY OF NEONATAL WITHDRAWAL

SYNDROMEPLACEMENT OF CHILD/CHILDREN OUTSIDE OF HOMECOMPLEX PERINATAL HISTORIES AND/OR OUTCOMESPSYCHIATRIC TREATMENT OR HOSPITAL ADMISSIONSAFFECTIVE DISORDERS INFANTS WITH LOW BIRTH WEIGHTSCHILD WITH SUDDEN INFANT DEATH SYNDROMEHISTORY OF DOMESTIC VIOLENCE

PROJECT LINKHISTORICAL Indicators

INCEST SURVIVORUNSTABLE/UNSUITABLE LIVING CONDITIONS HOMELESSNESSCIGARETTE SMOKING DURING PREGNANCYPSYCHOLOGICAL ISSUES: POOR SELF-

ESTEEM, DEPRESSION, GUILT, SHAMEERRATIC SCHOOL OR WORK HISTORYPOOR MEDICAL OR PRENATAL CARE HISTORY OF CHILD ABUSE OR NEGLECTPREVIOUS/CURRENT SUICIDE ATTEMPTSCITATIONS FOR DRIVING UNDER THE

INFLUENCEPREVIOUS/CURRENT CRIMINAL ACTIVITYPATTERN OF CAR ACCIDENTS

PROJECT LINK MEDICAL Indicators

LIVER DISEASE PANCREATITIS HYPERTENSION NEUROLOGIC DISORDERS GASTRITIS, ESOPHAGITIS POOR NUTRITIONAL

STATUS HEMATOLOGIC

DISORDERS SEROPOSITIVITY FOR HIV FREQUENT BACTERIAL

INFECTIONS ALCOHOLIC MYOPATHY SENSORY IMPAIRMENT PROBLEMS OF SEPSIS,

CELLULITIS HEPATITIS ABSCESSES CUTS AND BRUISES

SWELLING OF THE HANDS OVERDOSES WITHDRAWAL EFFECTS PULMONARY INFECTIONS HAIR LOSS ERRATIC MENSES POOR DENTAL HYGIENE UNKEMPT APPEARANCE ANEMIA TUBERCULOSIS SEXUALLY TRANSMITTED

DISEASES NO OR POOR PRENATAL

CARE MULTIPLE ABORTIONS

(SPONTANEOUS AND/OR ELECTIVE)

TARDIVE DYSKINESIA

PROJECT LINKSUBSTANCE USE SCREENING

INSTRUMENTS

REMEMBER:

YOU ARE SCREENING, NOT DIAGNOSING!


INSTRUMENTS

THE FOLLOWING SCREENING INSTRUMENTS ARE:

EASY TO REMEMBER AND ADMINISTER

TYPICALLY NON-THREATENING

OFTEN VALUABLE IN OPENING UP DISCUSSION ABOUT ALCOHOL AND DRUG USE

*THE 4 P’SCAGET-ACE* HTTP://WWW.HEALTHRECOVERY.ORG


INSTRUMENTS

DO YOU CONSIDER EITHER OR BOTH OF YOUR PARENTS TO BE AN ADDICT OR ALCOHOLIC?

DOES YOUR PARTNER HAVE A PROBLEM WITH DRUGS OR ALCOHOL?

HAVE YOU HAD A PROBLEM WITH DRUGS OR ALCOHOL IN THE PAST?

ARE YOU PRESENTLY USING DRUGS OR ALCOHOL?

THE 4 P’S:

ANY WOMAN WHO ANSWERS “YES” TO ONE OR MORE QUESTIONS SHOULD BE REFERRED FOR FURTHER ASSESSMENT.


INSTRUMENTS

C – HAVE YOU EVER FELT THE NEED TO CUT DOWN ON YOUR DRINKING OR DRUGGING?

A – HAVE YOU EVER FELT ANNOYED BY OTHERS’ CRITICISM OF YOUR DRINKING OR DRUGGING?

G – HAVE YOU EVER FELT GUILTY ABOUT YOUR DRINKING OR DRUG USE?

E – HAVE YOU EVER HAD A MORNING “EYE-OPENER” TO COUNTER THE EFFECTS OF HANGOVER OR TO STEADY YOUR NERVES?

CAGE:

IF A CLIENT ANSWERS “YES” TO TWO OR MORE OF THE FOLLOWING QUESTIONS, SHE SHOULD BE REFERRED FOR FURTHER ASSESSMENT.


INSTRUMENTS

T – HOW MANY DRINKS OR HOW MANY DRUGS DOES IT TAKE YOU TO GET HIGH? (TOLERANCE)

A – HAVE PEOPLE ANNOYED YOU BY CRITICIZING YOUR DRINKING OR DRUGGING?

C – HAVE YOU EVER FELT YOU OUGHT TO CUT DOWN ON YOUR DRINKING OR DRUGGING?

E – HAVE YOU EVER HAD A DRINK OR DRUG FIRST THING IN THE MORNING AS AN “EYE-OPENER” OR TO STEADY YOUR NERVES?

T-ACE:IF A WOMAN WHO ANSWERS MORE THAN TWO DRINKS ON THE TOLERANCE QUESTION IS SCORED 2 POINTS. EACH “YES” TO EACH OF THE ADDITIONAL THREE QUESTIONS GETS A SCORE OF “1”. A SCORE OF 2 OR MORE IS CONSIDERED A POSITIVE SCREEN, AND THE WOMAN SHOULD BE REFERRED FOR FURTHER ASSESSMENT.

presented by ashley cole, ma project link case manager region ten community services board p roject...

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