A new book by Gerald A. Juhnke does what few do — it combines a comprehensive overview of specific assessment functions that addiction counselors often perform daily, with a broad presentation of evaluative tests to choose from, and bundles it with experiential exercises to maximize learning. Juhnke’s text will be both highly useful to clinicians and particularly usable in educational situations. My students will certainly encounter this book in our future classes together.

Later, many of us found ourselves providing counseling services in new ways as treatment hospitals closed and money dried up. Often our task in a non-addiction treatment setting was to assess someone who may or may not qualify for an addiction diagnosis, and then to be able to defend our diagnostic formulation to a variety of parties who possessed a variety of bias. Today, our scope of practice demands proficiency in the assessment areas as stated in several of the 12 Core Functions of counseling in general use by the majority of licensure and certification processes nationally.

For senior clinicians, this book will validate what you already know, but add an appreciable amount of new insight. For the entry-level counselor, or student, this book will provide invaluable information and experiences for those who fully participate in the skill-building portions of the book. Regardless of the reader’s skill set, Juhnke prepares us to provide the very best assessment and diagnosis for today’s client in today’s treatment environment.

The first two chapters provide the reader a foundation on which to build the assessment process. As the preface states, “this text is founded upon the assumption that addictions assessment is more than a one-time paperwork procedure conducted at the onset of treatment to simply gather minimal facts and secure a [DSM-IV-TR] diagnosis to fulfill billing requirements.” The remaining chapters provide proven, practical directions on the assessment process itself and introduce the reader to Juhnke’s “Clinical Interviews Standardized Specialty, Drug Detection, and Personality Assessment,” or (CLISD-PA), which presents a “road-map” to guide the clinician through the process. Each chapter begins with a brief outline, followed by a listing of “learning objectives,” and ends with “skill builders” that enable the reader to experience the topic for themselves.

In Chapter 1, the author presents the CLISD-PA and guides the clinician in its use throughout major pieces of the book. In Chapter 2, he offers an excellent overview of the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) — Text Revision (2000), (DSM-IV-TR). Seldom is so much information packed into so little space, and although any writer can only reference the primary source, and this isn’t a replacement for the real thing, in this instance his 50-page chapter is a more than adequate resource for learning the fundamentals that are an absolute necessity for addiction counselors at any level of practice. If you were to peruse only this chapter, the book price would still be fair.

In Chapters 3 through 7 you will find information relating to clinical interviewing, an overview of standardized alcohol and other specialty assessment instruments and drug detection testing. The drug-testing information is especially valuable, as it is
seldom presented and we must be familiar with these tests and procedures when we encounter this assessment approach in our work. There are important sections on personality assessment and therapeutic feedback as well.

Gerald A. Juhnke is a writer of long standing, and this recent work is a classic! Substance Abuse Assessment and Diagnosis: A Comprehensive Guide for Counselors and Helping Professionals deserves a spot in every addiction treatment clinician’s library. It is full of indispensable information, is very readable, and promotes learning through uses of exercises and case examples. It deserves a prominent place in clinical training programs. You will know assessment and diagnosis after you have studied this book.

Lindsay E. Freese, MEd, MAC, LADC, is associate professor of Human Service at the New Hampshire Community Technical College in Concord, NH. Over the past 20 years he has worked in private practice and both clinically and administratively in residential programs. He is a past president of the New Hampshire Alcoholism and Drug Abuse Counselor Association.

Addiction counselors need to have the skills to screen for possible personality disorders in order to make appropriate referrals. Without treatment, individuals with personality disorders have a poor potential for recovery.

A DSM-IV-TR diagnosis is presented in five specific domain areas. This multiaxial system ensures that the counselor has at the very least considered a client’s status in five areas:

• Axis I: The presenting clinical disorders or conditions that are the primary focus of clinical attention
• Axis II: Personality disorders or mental retardation
• Axis III: General medical conditions
• Axis IV: Psychosocial and environmental problems or concerns
• Axis V: A global functioning assessment

TABLE 2.1 on page 13 of Juhnke’s book offers this example of a completed Five Axis diagnosis:

Diagnostic criteria describe various disorders in the manual, and each of these is catalogued with a number as you see above (e.g., 309.00). These numbers appear in charts along with the appropriate narrative description, but are mainly used when insurance claims are submitted to briefly indicate what treatment has occurred. You will note that, in a sense, no diagnosis requires a “diagnosis.” In these circumstances, the clinician uses “V Codes.” This person has no Axis II diagnosis, indicated by the V71.09. If they had an Axis II diagnosis, it generally would be a personality disorder. Occasionally, a clinician is unable to determine a diagnosis immediately. On Axis I, they might choose to indicate this by entering V799.9, “Diagnosis of Condition Deferred.” Although all diagnoses are treated, the notation “Principal Diagnosis” or “Reason for Visit” is indicated.

Juhnke states that there are “approximately 124 Axis I substance-related disorders within the DSM-IV-TR” (p. 15). They are all placed in Axis I but can be broken down further into a variety of categories starting with Substance Abuse and Substance Dependence. Substance Dependence is further defined by two “specifiers,” with physiological dependence, and without physiological dependence, which would indicate the presence of tolerance or withdrawal symptomatology or not. In addition, 1 of 4 “course” specifiers (Early Full Remission, Early Partial Remission, Sustained Full Remission, and Sustained Partial Remission) may be used to state the role of abstinence in the diagnosis.

The Substance Abuse Diagnosis deals more with patterns of distressing consequences, and it follows that these can be further narrowed given drug classification used, levels of intoxication,
complications of withdrawal, continuing on to substance-induced psychotic, mood, anxiety, sexual, and sleep disorders, etc. In addition to Substance Use Disorders, Juhnke reminds us that we must consider other Axis I Disorders such as posttraumatic stress disorder (PTSD), conduct disorder, and oppositional defiant disorder, which have a high occurrence rate in substance dependency. He presents a breakdown of conduct-disordered behavior, which “includes four main categories: aggressive behaviors that threaten or harm other people or animals, behaviors that caused damage to property, lying and stealing, and full violation of societal rules or norms” (p. 38). His book is full of these brief but important considerations for assessment. In this example, it is important to determine the age of onset of conduct disorder (childhood onset? adolescent onset?) as a subsequent Anti-Social Personality Disorder diagnosis in adulthood is predicated on this information. So many of our clients present with anti-social (and other) “traits” that may resolve further into sobriety that a sense of whether it pre-dated the addiction or not can be very helpful in developing our treatment planning.
We know, of course, that many of our diagnosable clients have other co-existing disorders, many of which affect personality. Personality disorders may be separated into three distinct clusters:

1. Odd or eccentric — Paranoid, schizoid, and schizotypal personality disorders
2. Anxious of fearful — Avoidant, dependent, and obsessive-compulsive personality disorders
3. Erratic, emotional, or dramatic (high prevalence of substance abusers in this category) — Antisocial, borderline, and narcissistic personality disorders (APA, 2000)
   Both Juhnke and the DSM-IV-TR go into much greater depth regarding these disorders, and it is important to study them.

Axis III Medical Conditions is a simple statement of them, and the Axis IV Global Area of Functioning (GAF) is a subjective observation. The DSM-IV-TR provides a listing of examples with suggested numerical scores ranging from Zero to 100.

—Lindsay E. Freese, MEd, MAC, LADC

Reference
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed., text revision). Washington, DC: Author.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2003, v.4, n.5, pp. 68-69.

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darlene posey   |67.85.210.xxx |2008-08-10 19:27:17 i found this article extremely heplful. Does anyone know the name of his book? Reply 0   0

A   |68.195.26.xxx |2008-06-12 20:17:42 [smiley=cool] Personality disorders clusters seems to be mixed up: cluster A is 1, cluster B is 3 and cluster C is 2. Correct me if I am wrong. Reply 0   0

hu   |71.146.11.xxx |2007-12-09 22:55:25 [smiley=evil] Reply 0   0

C. Wainwright   |71.230.204.xxx |2007-07-16 09:17:31 [smiley=happy] I found the article very well presented and it provided some additional insight for my current research. Thanks! Reply 0   0

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