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Diagnosis Fog 1: Addiction/Substance Abuse and Mental Health Diagnosis

Recently I got a call from a colleague who had just admitted a patient into his co-ocurring treatment program (mental illness and addiction)–he wanted to get my thoughts about a patient. The young woman came in with her family and they were quite worried. In less than three years she had received three different diagnoses from three different mental health professionals all of which took place while she was actively using drugs.

I hear stories like this all the time concerning patients with severe and not-so-severe problems. Substance abuse or addiction makes it very difficult for a psychotherapist to accurately make a diagnosis in the first place. I have a suggestion for patients who find themselves in this position–which isn’t at all uncommon, by the way. If you do receive a diagnosis (whether it be anxiety, depression, or other problem)while you are actively abusing alcohol or drugs, you should speak openly to the doctor about your substance abuse so that he can take that into consideration.

I also recomend you begin a course of treatment to abstain from all mood-altering substances for at least 6-8 months, and then ask to be reevaluated and have your diagnosis confirmed or changed. The key word here is: ask and don’t assume your doctor or therapist will automatically do this.

Remember, if you are prescribed medications while you are abusing drugs or alcohol, it is very important to be frank with any professional you see, including one who might prescribe medication for you. Make sure you ask him or her about side-effects and what possible problems might be caused by taking medication and alcohol or drugs at the same time. Medication might even be rendered ineffective or harmful if taken while abusing substances.

You also might want to ask about if you are a good candidate for anti-craving medication. This combined with talk therapy might help you stay off drugs or alcohol if it is used properly, but it isn’t for everyone.

Always check with a mental health professional and/or M.D. before following any course of action including those posted in this blog.

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By richard – November 6, 2009

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"A valuable resource for patients and practitioners alike, setting the standard for therapy and counseling practice. If you know anyone considering therapy, or who is unhappy with their therapist, make sure they read this book."

-Tom Butler-Bowdon, author of 50 Psychology Classics, 50 Self-Help Classics

Amazon Bestseller, NAMI (National Alliance of Mental Illness) Advocate Book Pick, Dec., 2009

From Therapy Revolution (HCI Books), Chapter 4, Focus on Your First Appointment, Page 90

For Therapy Patients, Their Families, and Support Networks: You need to be prepared for every step of therapy, from finding a therapist, to the first few visits, to the very last session, and beyond. Become an educated patient and you will get more effective treatment.

During your first or second psychotherapy session, your therapist will ask you plenty of questions (and write down all your answers) in order to get to know as much as possible about you. These questions are collectively known as the Evaluation or the Biopsychosocial History. This and other useful checklists, charts, and questionnaires are included in Therapy Revolution, along with easy-to-understand tips and pointers, real-life patient interviews, and more.

Biopsychosocial History/Evaluation Checklist
[When your therapist does your evaluation], make sure that at least the following topics are included in the questions he or she asks:

1. Identifying data/demographic data (social security number, date of birth, sex, race, emergency contact information, living situation)
2. Alcohol and drug history (including over-the-counter and prescription medications, herbal or nutritional remedies, and illegal drugs and alcohol; how drugs are administered; frequency of use; age first used; date last used; progression of use; withdrawal symptoms; history of treatment programs/hospitalizations; symptoms and complications of alcohol and drug history)
3. Mental health history (including medication history and compliance, allergies to medications, history of treatment programs/hospitalizations, and symptoms and complications of that history, including harm to self or others)
4. Medical history (including medication history and compliance, allergies to medications, hospitalizations, chronic and/or life-threatening illnesses, and symptoms and past and current complications of that history)
5. Other topics (sexual history, educational history, vocational history, financial history, legal history, social history, family/significant other, gambling history, nicotine history, eating disorders, spirituality, leisure, military history)
6. Reason for seeking treatment
7. Questions specific to present stage of life (childhood, adolescence, geriatric, etc., as needed)

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