Screening tools are not designed to make diagnoses. They can give evidence that a problem exists. However, there is no guarantee that one screening tool or even one assessment or type of data will yield the necessary data to inform the addictions professional about a potential treatment plan and next steps. This is why addictions professionals may have to seek multiple (also known as multimodal) data sources from which to elicit sufficient data on an individual.

In this Discussion, you will consider what you might do in a hypothetical situation in which a client's scores on a screening tool are insufficient for the purposes of interpretation.

To prepare:

Review the article "Screening for Alcohol Problems: What Makes a Test Effective?"

Review the data collected for the diagnostic summary for Jane Roberts (pseudonym "Patty") in Chemical Dependency Counseling: A Practical Guide, Appendix 6 (pp. 262-263) (See below for Jane Roberts diagnostic case summary)

Jane Roberts case summary

Jane is single and a beautician. Father died when she was young. She was raised by an emotionally distant alcoholic mother. She felt abandoned all her life which led to her drinking starting in her teenage years. She strived for affection and attention from other men which led to addiction to sex. Was confused between sex and love. She has men who were abusive, which led to her not having assertive skills to the point where she had trouble for asking what she wanted and problems expressing how she feels. Her alcohol started increasing, which led to her take valium to sleep. Therefore, addiction to valium increased to double the dosage. She has no social system except for her boyfriend of 2 months. The psychological testing showed she is emotionally unstable and manipulative. She breaks the rules of society to get her own way. She is suffering from mild depressive symptoms, along with daily anxiety.

Jane Roberts problems are as follows:

1. Extended withdrawal from alcohol and valium, as evidence by autonomic arousal and elevated vital signs.

2. Inability to maintain sobriety outside a structured program of recovery, as evidenced by client having tried to quit using chemicals many times unsuccessfully.

3. Anemia, as evidenced by chronic history of low red blood cell counts.

4. Upper respiratory infection, as evidenced by sore throat and rhinitis.

5. Fear of rejection and abandonment, as evidenced by client feeling abandoned by both her mother and her father now clinging to relationships even when abusive.

6. Poor relationship skills, as evidenced by client not sharing the truth about how she feels or asking for what she wants, leaving her unable to establish and maintain intimate relationships.

7. Dishonesty, as evidenced by client chronically lying about her chemical use history.

8. Poor assertiveness skills, as evidenced by client allowing other people to make important decisions for her, inhibiting her from developing a self-directed program of recovery.

Review the introduction scenario featuring Terrence. Terrence is faced with a client, Angela, who is presenting several problems (See below)

Your written assignment is to response to the following questions below regarding Terrence:

Consider the following scenario:

Terrence is considering next steps for a client, Angela, who has come for therapy at the family counseling center where he works. When Angela scheduled her appointment on the telephone, she had described her concerns with marital difficulties, insomnia, and depression. During her first session, however, Terrence noticed that Angela had a very nervous demeanor, picked at her skin constantly, and had a rasping cough. When Terrence asked Angela about her employment, she admitted that she had lost her job and that her husband was angry about it. She said she was afraid her husband was on the brink of becoming abusive. Terrence is not sure what to do first. He suspects Angela might have a substance addiction, but clearly she has several interlocking problems, and many are urgent.

What sources of data might Terrence collect in order to understand the client's problems? Explain why you chose each source. Finally, provide a rationale for the number of sources you recommend.

References: Stewart, S. H., & Connors, G. J. (2004-2005). Screening for alcohol problems: What makes a test effective? Alcohol Research & Health, 28(1), 5-16.