An interesting aspect about mental health is that it involves a wide scope of psychological issues. Despite some of these conditions having similar symptoms, in some cases, mental health experts have developed criteria which differentiates them. For instance, bipolar disorder and depression share some symptoms but a mental health professional will be able to distinguish individuals suffering from either condition. While that is the case, understanding the ambit of mental health issues could help clarify the different categories of psychological disorders which experts have created. For instance, such one would understand what it means that an individual is an addict and not substance dependent or whether these two concepts refer to the same thing.
Mental health experts have developed various strategies, which they use when identifying the type, and extent/severity of psychological issue a patient is presenting. The DSM-V outlines a particular criterion which categorizes the severity of disorders using symptoms. For instance, when assessing for substance related and addictive disorders, two – three symptoms signal a mild disorder, four- five symptoms a moderate disorder, and six or more symptoms a severe disorder (How we diagnose, n.d.). Thus, whenever a patient is being diagnosed, he or she is exposed to a process that focuses on identifying the presence of various symptoms. The more the symptoms, the greater the severity of the disorder. Straussner (2013) explained that as indicated in DSM-5, diagnosing an individual with a specific substance use disorder a clinician should confirm that the patient has had a problematic pattern of use of a particular substance thereby leading to clinically significant impaired. Furthermore, the individual must meet a certain criterion as pertains to the symptoms presented. He or she must have two or more of 11 symptoms that must have occurred with a 12-month period. Some of the symptoms include: consuming the substance in larger amounts or over a long period, continued use regardless of social and interpersonal issues, recurrent use resulting in failure to fulfill obligations, as well as an unsuccessful attempt control the use of the substance (Straussner, 2013).
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A review of the information that Straussner (2013) provides alongside with the criteria the DSM-5 uses to determine the severity of disorders, it becomes evident that when applying these instruments, clinicians already have a target in mind. In the case of substance related disorders, they focus on whether a client presents some of the symptoms outlined in the DSM-% criteria. One of the instruments used is called CAGE (cut down, annoyed, guilty, eye-opener). Cherpitel (1997) noted that under CAGE, a patient is required to answer four questions. For instance, when assessing the possibility for an alcohol problem, a clinician would ask the following questions:
Have you ever you should cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
(Cherpitel, 1997).
From the questions above, it is evident that part of the aim of the instrument is to identify the client’s inability to stop using a particular substance, or whether its consumption has brought about social-relational issues. These two aspects are considered fundamental in showing whether an individual is suffering from an addictive disorder or not.
The process of administering instruments would not, to some extent, be a motivating factor for an individual with addiction to seek treatment. For instance, one could analyze the four questions which are used under CAGE. Cherpitel (1997) confirmed that the use of instruments varies considerably when it comes to their performance among different populations. This means that a particular instrument might not be within what a certain population group expects. Such aspects as specificity and sensitivity towards diversity issues determine the acceptability and thus applicability of instruments. Cherpitel (1997) explained that compared to other instruments, the Rapid Alcohol Problems Screen (RAPS) “… outperformed the other screening instruments in several population subgroups” (p. 351). Therefore, it is important to consider that when choosing an instrument, a clinician should anticipate its ineffectiveness as different population subgroups respond differently to the methods of assessment clinicians use. Thus, it is upon mental health experts to determine what instrument bests suits a particular population subgroup.
Various instruments are used to assess the possibility of substance use disorder in clients. The DSM-5 outline various items such as spending considerable amount of time trying to acquire the substance, craving, recurrent use as well as withdrawal from important social roles (How we diagnose, n.d.). The Rapid Assessment Instruments focus on an individual being annoyed when the substance use behavior is addressed, whether one is a normal drinker, waking in the morning and not remembering about events that occurred in the previous evening, or whether a close friend or relative is complaining about the substance use behavior. Multi-dimensional Instruments have items such as the period of use of a substance, rate of hospitalization, or whether one has chronic medical problems associated with the behavior in question (How we diagnose, n.d.). Notably, the question of how long an individual has been using a particular substance is present in both DSM-5 and the Addiction Severity Index, which is under Multi-dimensional Instruments. The question about the impact on social life is evident in DSM-5, CAGE and ASI. However, one of the items in the Rapid Assessment Instruments is whether an individual considers him or herself a normal drinker. Relative to the DSM-5 criteria, it is not clear what being a normal drinker means. The items under DSM-5 do not address anything about the type of drinker or substance user an individual is. The majority of items address an individual’s lack of capacity to function thereby leading to social and personal problems.
References
Cherpitel, C. (1997). Brief screening instruments for alcoholism. Alcohol Health & Research World, 21 (4): 349-351.
How we diagnose. (n.d.). [PowerPoint Slides].
Straussner, L. (2013). T he DSM–5 Diagnostic Criteria: What's new? Journal of Social Work Practice in the Addictions, 13 (4): 448-453. DOI:10.1080/1533256X.2013.840199
