This section guides counselors through the assessment session. It outlines strategies for assessing individuals who present for Brief Marijuana Dependence Counseling (BMDC) treatment. These people have been determined to be appropriate for treatment based on a brief telephone contact or an initial triage or evaluation appointment.
The BMDC assessment session focuses on building rapport with the client while assessing his or her marijuana use. This section includes diagnosis and assessment instruments. The assessment findings are used to complete the Personal Feedback Report (PFR), which the counselor reviews with the client in subsequent sessions. An accurate assessment provides data that can be used as
• A starting point for therapy
• Motivation and feedback for the client
• A measure of therapy outcomes over time.
Building Rapport
One of the most important aspects of treatment, especially during the assessment session, is building rapport; through expressions of warmth, support, and empathy, the counselor gets to know the client. Although the assessment session focuses primarily on gathering information, the rapport established during this session defines the client–counselor relationship for remaining sessions.
Assessing Marijuana Use
BMDC uses the criteria identified in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), to diagnose marijuana dependence (exhibit IV-I) and marijuana abuse (exhibit IV-2). These criteria help the counselor determine a client’s level of substance involvement and the associated consequences, as well as appropriate level of treatment. These criteria also can be used in later sessions to measure treatment effectiveness.
The symptoms of substance dependence typically are assessed first; substance abuse is considered a less severe substance use disorder, and its symptoms are assessed only if the client does not meet the criteria for a diagnosis of substance dependence. For this reason, tolerance, withdrawal, and symptoms describing impaired control over use are not included in the diagnosis of substance abuse. However, it may be useful to complete the assessment of abuse criteria even if dependence has been diagnosed to learn more about the nature and extent of negative consequences that result from the dependent use pattern.
The guidelines presented here will help the counselor make a diagnosis of marijuana dependence or abuse. If the counselor does not have the credentials required for making a diagnosis, he or she must receive verification from a State-qualified individual.
Exhibit IV-I. DSM-IV Substance Dependence Criteria
1. Tolerance, as defined by either of the following:
• A need for markedly increased amounts of the substance to achieve intoxication or
desired effect
• Markedly diminished effect with continued use of the same amount of the
substance.
2. Withdrawal, as manifested by either of the following:
• The characteristic withdrawal syndrome for the substance
• The substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused by or exacerbated by the substance.
Exhibit IV-2. DSM-IV Substance Abuse Criteria
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
2. Recurrent substance use in situations in which it is physically hazardous
3. Recurrent substance-related legal problems
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused by the effects of the substance