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Overview

Chemical Dependency

Chemical dependency evaluation is a complex diagnostic task. The use of questionnaires and detailed history is a vital part of these diagnostic procedures. Often, patients will agree that contact persons, identified by the patient as objective and outside the immediate family, can be contacted for information and support. Neuropsychological assessment is helpful when cognitive problems are a result of chemical dependency.

Psychological evaluation following a period of abstinence is used to help the patient identify personality strengths and weaknesses that will impact recovery. Discovering a person's recurrent and problematic patterns is very helpful to ensure successful progress.

A commonly overlooked topic to be addressed is the treatment of the chemically dependent individuals' sexuality and ability to relate to another in an intimate manner. With regard to chemical dependency psychotherapy, the role of the psychotherapist in the first phase of recovery is largely limited to support and clarification. As an individual gains sobriety time and has established support groups or individual psychotherapy, one can begin to explore the emotions that are often a large part of the addiction picture. Emotions develop and become more clearly defined and understood as an individual observes them in a safe setting. A chemically dependent individual is often not aware or understanding of their emotions and consequently not in control. Oddly, for a chemically dependent individual to be in control, too often it means that they need to remove themselves from the pain of emotion. The fear associated with being out of control will cause individuals to revert back to "whatever established patterns they use to feel in control." Aside from the purely physiological addiction process, somewhere in a person's life, a connection is made that a drug can help with the control process. Psychologically, the individual may realize at some point that they now "need" the drug to cope. Ironically, at this point, an individual may percieve that he has an alcohol or drug use problem and must additionally fight to control the addictive process itself. The cortex, just as it helps us satisfy other needs, begins to find ways of securing a feeling of homeostasis or peace. Many sorts of defense mechanisms, most commonly the strategy of denial, become a therapeutic adversary to recovery.

A counselor in this field would be advised to be clear about providing the patient structure with regard to appointment times, fees and the time of each session. If the patient's life is unmanageable, they may need further clear guidelines that are firm but fair.

Conversely, it is important as a treating professional not to allow the patient's pathology to create unmanageability in the professional's life. Often in therapy, there is a continued need to be in control and a patient may consciously or unconsciously manipulate to gain it.

Though some professionals adhere to the 12-step program more closely than others, it is wise to clarify the process of change with the client by being aware of the 12 steps of Alcoholics Anonymous for support, clarity and to establish a homogeneous peer group.

It is quite important that the professional accept the patient's defenses even when they are excessive during early recovery. Support will include identifying the appropriate and adaptive behaviors and only later in the process can the maladaptive component be uncovered. Doing so too early in the process causes a rise in anxiety and a need to be in control once again, often not in a healthy fashion.

Relapse, is in itself destructive, can be used in a constructive manner to lead to an increase in trust and understanding the client feels towards the therapist.

Perhaps stronger than most other diagnostic groups, the chemically dependent patient develops a powerful transference or emotional relationship with the therapist. In this context, an emotional relationship does not always mean affection or love, but may in fact mean anger. The therapeutic process can stimulate a great deal of emotional turbulence. Understanding that such a powerful dependent transference can cause a great deal of ambivalence, the Alcoholics Anonymous program or support group can give a much needed safety valve to the client. Helping the patient find alternative coping "tools" that they can use regularly toward health can reestablish in a healthy way a sense of control.

The criteria for substance dependence will include indications of a maladaptive pattern of use over at least a one-year period of time. Most individuals with a dependency problem will have an increased tolerance, difficulties when they withdraw from the chemical, and characteristics of use which can be characterized as larger amounts of substance over longer periods of time. Often, an individual will report efforts to unsuccessfully control their substance use.

It is important to evaluate the social effects the chemical has on one's life, their occupation, or even recreational activities. Various questionnaires have been used in hopes of assisting in the diagnosis of chemically dependent patients. Various straightforward but not well-disguised questionnaires such as the Michigan Alcohol Screening Test are available. The Minnesota Multiphasic Personality Inventory-2 provides an independent scale (MacAndrew Scale). This subtest is perhaps the least overt questionnaire of chemical dependency problems and though there have been disagreements in the literature of its utility in the final diagnosis, few individuals discount the fact that it is a helpful part in the diagnostic process.

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