Biomedical Applications to Addiction Counseling: Assessment, Techniques and Interventions – Clinical Implications for Counselors

Counselors

Assessment

When meeting with a new client who is requesting services for a substance use disorder, standard procedure is to conduct a thorough biopsychosocial assessment which examines ways in which the clients alcohol and/or drug use has impacted on him or her physically or biologically, psychologically (e.g. emotionally and cognitively) and socially (e.g. interpersonal relationships with family and friends). When doing a biopsychosocial assessment, it’s important to gather information pertaining to family history, not only to explore how substance use has impacted on important familial relationships but also to explore possible genetic influences or genetic risk factors. Based on the genetic theory, the supposition is “the more blood relatives one has who have substance use disorders, the higher the risk in their sons or daughters.” So how do we collect family history? The best way is to use a genogram (McGoldrick & Gerson, 1985). A genogram is a shortcut way to gather family history using a series of symbols (see Figure 4.1; see also Figure 5.2) According to Monica McGoldrick and Randy Gerson (1985), who originated this technique for gathering family history, it’s best to begin by asking clients to provide the names and approximate ages of their immediate family: parents, siblings, grandparents, aunts, uncles cousins, etc. It’s important to note who’s deceased by placing an X through their circle (for women) or square (for men) and then asking what caused his or her death. It’s then important to ask about any divorces, separations or other disruptions in family structure. McGoldrick suggests that it’s best to begin by then asking about the client’s family history of medical problems (e.g. diagnosed medical disorders as well as hospitalizations or other treatments he or she may have received), before asking about more personal information such as histories of mental health or substance use disorders. In gathering family history on substance use disorders rather than starting off with a question like, “So, does anyone in your family have drinking or drug problems?” it’s more helpful to begin with less threatening questions, such as “Tell me something about what was considered acceptable drinking in your family when you were growing up.” Or, “Was alcohol usually a part of celebrations like holidays or birthdays?” and “If so, what was considered acceptable use of alcohol?” The questioning would then move to asking if anyone in the family was considered to have an alcohol or drug problem by other family members. Also, did anyone in the family ever go for help for a drink or drug use problem? Or, “Has anyone in your family ever gone for help by attending Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)?”

Figure 5.2 Genogram Illustrating Alcoholism on Paternal Side Source: www.pinterest.coin/pin/80009330860167913/

By exploring the family’s mental health history, we are also trying to find risk factors for substance use disorders. As mentioned earlier, there are particular mental health disorders which tend to correlate or coexist with SUDs, such as bipolar disorder, PTSD, eating disorders and depressive disorders. McGoldrick recommends starting off with less threatening questions. Start by asking if any family members ever experienced any problems with coping with daily life? Then ask if any family members had experienced any emotional coping problems. Then ask if any family members had ever received help for emotional problems, whether they may have been hospitalized and whether any family member was ever prescribed medication for emotional problems? Be aware that if a client were to say, “My Aunt Mabel was hospitalized for a ‘nervous breakdown’ back in 1987” it would then be necessary to ask what types of problems Aunt Mabel might have been experiencing. A “nervous breakdown” can mean anything (e.g. a suicide attempt, major depression, a manic episode or detoxification for alcohol or drug dependence). There is no such diagnosis as a “nervous breakdown” in the DSM-5 or any of its earlier editions. Therefore, it’s important that counselors try to decipher what clients means when using this colloquial term. In the Family Models chapter, we discussed the use of genograms. However, as opposed to focusing on the family’s medical/substance use history, we also used genograms to assess family structure and dynamics.

We wish we could say there are definitive genetic tests for substance use disorder potential or risk, just as there is for Huntingtons Disease and for certain developmental disabilities like Down syndrome. The best type of test available for SUDs is what is referred to as “an alcohol skin flush” genetic test which is available through genetic testing for medical problems by companies such as “23 and Me” and CriGenetics. The alcohol skin flush test determines which individuals are likely to experience a skin flush reaction when drinking alcohol. Those who experience this reaction are thought to be a lower risk for developing alcoholism. The flushing reaction is said to be very uncomfortable (face and neck become hot and red, nauseous feelings are also common) therefore drinking alcohol becomes an unpleasant or aversive experience.The skin flush is thought to be the result of a build-up of acetaldehyde (a by-product that’s produced when alcohol is ingested). It is thought to be most common in people of East Asian ancestry, which may account for why Japanese, Burmese,Thai, and Chinese have lower rates of alcohol use disorders. The drug Antabuse, which is used to help treat alcoholism works by preventing the liver from breaking down acetaldehyde. Therefore, when a person taking Antabuse drinks alcohol, it is like they are poisoning themselves in that they experience an extreme skin flush reaction, nausea, vomiting and extreme discomfort.

Learning Opportunity 5.4 — Antabuse

Although Antabuse is not as popular today as when it was first developed back in the 1960s, it may still be useful with some individuals. See what you can find out about how Antabuse works and how it may be helpfill in the treatment of alcohol use disorders. What model best explains how Antabuse works? If you had a close friend or relative who is diagnosed with an alcohol use disorder, would you recommend that they take Antabuse to help them manage cravings to drink?