integrated detection and assessment of both substance use disorder and mental illness is most effective if it is done at the same time by the same clinical team assessment usually occurs over time during the engagement and persuasion stages of treatment during the assessment the clinician learns about the context of substance use as well as symptoms of abuse and dependence so we can clarify the diagnosis the comprehensive longitudinal assessment describes functioning symptoms treatment and interactions between all of these in this type of assessment mental illness and substance use information is integrated it's helpful to get information over
long periods of time during different periods of functioning so that you can assess how mental illness symptoms and the substance use disorder interact more often than not you'll need to get this information from clients in bits and pieces over many meetings you'll also want to include information you get from records and from family members in a moment you'll see a part of an interview of a young man with schizophrenia and a substance use disorder the interviewer is trying to do a comprehensive longitudinal assessment notice how she uses a non-judgmental attitude that allows the client to
be honest about his substance use although you won't see enough to be able to make a diagnosis try to see if you can figure out what stage of treatment this client is in so you got some really good things going on you you've got oh yeah yeah you know I try to keep myself uh busy and stuff you know I mean though I drink you know on and off every day pretty much you know but uh that's just my thing you know takes the edge away from life you know what I mean takes yeah so
there's some good things about drinking yeah there are some good things you know it isn't all bad you know but if you abuse it I it's really bad yeah you can we talk a little bit about the impact that your drinking has had on your life I don't know I I really uh I uh I I started drinking heavy only like uh four or five years ago I think or something like that that was um in relation to the medicine you R yeah yeah the hell off DE eight yeah it helped with the side effects
yeah cuz I Ian it was really ripping me apart inside you know and no one would do nothing they give me coach jenton but coach jenton made it worse dried you Thro up and stuff so the alcohol took the edge off oh yeah yeah it helped a lot Ellen how old were you when you had your first drink ever just regular drink about five years old about five how did they I had a toothache and my parents gave me some whiskey did you remember how you felt huh did you remember how you felt I felt
good yeah toothache go away yeah toothache went away and I went to bed you know and I would drink on and off like as a k cuz my sisters they used to fix panina coladas and stuff like that and I wanted to be grown up like them you know drink coffee and drink this so I drink they give me a White Russian once in a while how old were you then a this is all through my youth so maybe around 10 or so I mean during Christmas they break out the ver uh this Galla Yellow
Stone know what it was comes in us oh the stuff you make Harvey Wallbangers with yeah probably what it's called but I know what you're talking about liquor liquor taste to it yeah it's really good expensive yeah but yeah they they break it out during you know holidays like Thanksgiving Christmas something like that so when did you first start drinking for yourself regularly oh jeez I I really I would say about 26 27 something like that so was a teenager you didn't drink much oh I drank yeah but I you I mostly smoked with marijuana
okay I smoked a lot of grass and when did you start what what age were you started doing that about 15 16 okay yeah and then you were just kind of drinking then about once a week maybe yeah I would I wouldn't drink like all the time I was a social Drinker started out social Drinker okay but you know I I grew up where you know if you're going to drink you're going to get drunk you know that's that's the whole point of drinking you know you don't drink just don't drink to enjoy drink to
get drunk yeah you drink to get drunk yeah sort of like my uh my uh generation I think a lot of generations grew up with that oh yeah so you started smoking pot when you were around 13 or so about 14 yeah yeah and how much were you smoking not much I could never afford it that much you know but my friends would always get me high and stuff you know so a few times a week yeah a few times a week was it pretty pure stuff alen or was it laced with stuff no it
wasn't laced with anything it was uh regular weed no no I can't say I had any angel dust or anything like that no okay when did you first start uh you mentioned drinking coffee uh do you use a lot of caffeine do I use a lot of caffeine do you drink drink a lot of water okay do you drink a lot of soda or no not really not really I have soda once in a while but okay you know um what other drugs have you tried have you ever tried uh LSD yeah I've definitely done
a couple trips yeah how old were you when you first started to do that I was like 17 18 okay and how long did you use LSD for I only did like three or four trips okay you know three or four do you remember how you I remembered the whole trip yeah Ellen how come you stopped after three or four did you just I don't know it's just like friends faded away you know connections got cut you know I don't know did you like that effect oh yeah oh yeah I like acid okay what about
speed not really much of a speed I know no cocaine no no cocaine um over the counter medicines oh yeah I I had my time doing that what what kind of benro Y you know I take I took 24 of those pills I mean God damn wake up you don't even know where the hell you are right right when was the last time you used benad drill oh I I swore it off that was back in 90 uh 92 93 Oh see it's been a long time yeah it's been a while yeah okay yeah it's
a cheap man ey Yeah well yeah yeah how about um pills do you ever get any pills no I don't do anything like that no no no I don't do that what about heroin I've tried heroin once how long ago I like backing uh 94 I think 94 ' 95 when I had Section 8 in Pon had a really good apartment and I let people into it and uh they got me evicted did you just use it a few times yeah just just a few times smoke it or shoot it or snorted it snorted it
okay yeah remember how it made you feel yeah real good yeah yeah yeah and I didn't get sick you're supposed to get sick sick I guess but I didn't get sick I just kind of like knotted out so when was the last time you used heroin uh 96 I think it was okay and when was the last time you smoked pot pot last month okay and when was the last time you had something to drink uh just yesterday yesterday last night maybe yeah yeah last night yeah okay that's the last time you had a drink
last time I had a drink that's a good question I had a drink last weekend last weekend glass of wine wow that's that's good for you they say red wine is very good for you well actually this was pink wine so pink huh yeah I only like the red really red red wines yeah we had a celebration so well that's good yeah how about um what medication are you on now what are you taking zxa in h off you're still on hell off yeah they they want take but it's it's been reduced from when it
they used to shoot me up every week I mean that stuff was painful yeah but uh now they just shoot me up once a month okay so which is very good you know and the zyx is supposed to level off uh with uh uh what's it called held off do you know how much held off you get once a month 3/4 of a cc okay all right and how much Dix you take a day I take 50 milligrams a day and you said that the voices have gone away yeah they have yeah okay any other
drugs that you might have used that I might have forgotten to ask you about mushrooms no never really had mushrooms no no what about ecstasy no I won't touch that stuff no way I I don't trust it you okay oxycotton what's oxycotton what's the new drug that's out that oh really I don't even know I I'm not in touch with that oh well I have to keep up on these things alen um it's it's out on the street it's a painkiller it's a opiate opiate it's out on the street that some people are abusing yeah
pretty rly you heard of ice mhm you use that no no I heard is like really uh really potent like sort of like a beote yeah what about meth aneto never heard of it crystal meth oh yeah Crystal math I heard of that but I never tried it you ever had a blackout when you've been drinking oh yeah I've had blackouts you know not lately anyways but you know I I I'd have blackouts once in a while do you ever get shaky the next morning yeah I get shaky and stuff do is it hard to
eat the next morning no no you can eat okay yeah yeah what's your tolerance like alen how much can you drink I can't drink a whole lot I mean uh three beers and I'm pretty much toasted okay has it always been that way but there're 16 o yeah 16 o well that's I think that's that's about four or five beers yeah okay 36 Oz beers and you're pretty toasted yeah is there when you were younger could you drink more no no I I just drank for the effect you know and uh once I had the
effect you know it was just it was it was growing up socially like you know my parents were okay with it and stuff like that but so at any point did you ever drink like two six packs a day I mean were ever like a guy who used to really pound him back I I could never uh I can never pound I mean I drink whiskey and I have just a glass of that how how big a glass are we talking a 8 oz glass like a shot like maybe a little juice class about four
shots about four shots okay and how's that make you feel good makes feel good yeah do you tend to black out when you have both whisky and beer beer no no I just drink to a certain sometimes I don't even finish the the cup you know I just drink when I feel tired I go to bed okay all right you ever been uh rested for DWI yeah I've been rested for DWI when Back in 88 okay I haven't had a license since really yes did you go through the whole course and I went to Amethyst
they said do six months of AA and I said I'll never do it and so you know I never did I'm very stubborn yeah so you're just you haven't had a license since then no and I'm a habitual offender so that uh tell me about that what do you mean by that well driving habitually without a license okay okay I got caught in uh 97 and I did eight months you know four months good time eight months you know they say if I get caught again uh I do one and a half to three up
in the big house so are you currently driving without a license no no no I wish I was man I don't know you want to take that chance I don't know I have to go to a different state yeah not New Hampshire I think it's called like geographical cure yeah geographical cure you can call it what you you know I mean there was a time where uh I split for like two two months I was dishwashing in bajaba made a good money I was working 60 70 hours a week it's a nice place yeah it
is nice and were you drinking up there oh yeah I was drink going in drunk but I worked you know I I kept my job have you ever lost a job because you're drinking uh I can't really recall I don't think so I mean I would just quit a job just because I wanted to quit okay not because you want to drink or smoke pot no no just because you wanted to quit yeah yeah when when you drink and smoke pot how's that affect your voices how does that affect your mental illness I don't know
I just uh I just drink and smoke pot you know do the voices become more clearer do they increase they decrease they're gone they're gone they go away yeah I keep them at Bay okay so the drinking in the pot helps keep the voices away yeah pretty much I mean drinking yeah have you ever lost an apartment you mentioned your section I've gotten evicted everywhere because of the people you're hanging around with what about have you ever lost an apartment because of your alcohol or drug use uh yeah I don't know if it was my
alcohol or drug use but there was always a reason I got evicted or something you know okay how much more time would you like uh maybe five more minutes five more minutes this far okay okay um so you've mentioned to kind of like sum this up that uh you had your first drink of alcohol when you were five yeah and uh now correct me if I'm wrong and from about 5 to 14 you might have had a drink here in there because you wanted to be like your sisters and you know drink just the occasions
when you wanted to feel grown up Y and then when you were around six 14 15 you started to smoke pot yeah and um that helped you feel more relaxed relaxed okay uh and so you started to drink when you were in your teens but it really wasn't a lot yeah you just drank more more or less smoke a marijuana smoke more marijuana than you drank and then when you around 23 that's when your mental illness started and you began to hear voices um did you have any behavior that was different besides the voices alen
that people were concerned about did you feel paranoid did you yeah I feel paranoid at times paranoid okay I heard voices were any stressors going on then I don't know were you in college then no I wasn't you were out of college yeah I was out of college okay um and since you've been 23 it sounds like um you've used mostly alcohol and marijuana yeah basically I stay away from everything else away from although you did experiment a little bit with some of it yeah as a late teen your late teens early 20s yeah yeah
and um it sounds like you've had some blackouts you've been able to keep your jobs even though you've sometimes gone to work drinking or under the influence um you've lost some apartments because of maybe the people you were hanging out with when you were drinking and Drug exactly and what about schooling did your drinking and drug use have anything to do with not finishing school no I finished school okay you got your graduated you got your diploma okay and what about college You' mentioned about no I only did a couple weeks at College okay but
uh I ended up going to prep school for six months okay which is just like college right and you stopped that because well I just uh get sick of it went back to Port some paper okay you know right wanted to live on my own you know right and most recently you've been um living on your own since October you've been working up until last month when you lost your job yeah and you're drinking pretty much every day yeah drink just about every day and smoking pot no not really smoking pot maybe once a week
or so yeah about that maybe all right and currently right now you feel like the alcohol that you're using is working for you there's you you got some good things happening yeah it works all right I I try to keep it under control okay are there any things that aren't working in terms of your Al use right now no not that I know okay so it's not getting in the way of managing your apartment or having food enough food for the week or getting a job yeah I'll get a job you know so you don't
see your alcohol use is getting in the way of any of those things right now no no and basically what it's helping you do is feel more relaxed and go to bed yeah and helps you sleep at night yeah yeah exactly right okay so for today what do you what is the thing that you most want to work on and that you're most concerned about just getting a job okay so getting a job is the thing that you really want yeah just get a job and uh hopefully uh if business picks up I'll get my
old job back okay you know right so the goal I guess for today is to work on getting a job yeah look in the paper and stuff yeah that's that's that's where I stay focused y always the green always the green yeah that's important oh yeah it's very important yeah okay it's also important to complete a contextual assessment of substance use for each of your clients the context of substance use includes when your client uses with whom how he uses how much and why it includes the cues or triggers to use and the consequences of
use a useful technique to complete a contextual assessment is to ask your client to describe a day in detail this information is essential to gather before you develop a treatment plan or try to help your client cut back or quit using substances when asking your client about his substance use it's important to find out what internal and external cues lead to using substances internal cues include thoughts emotions and craving external cues include people places activities and things it's also important to find out about consequences of use common positive consequences of use include friendship relief from
distress enjoyment and relief from craving common negative consequences of use are interpersonal problems financial problems and being institutionalized in the following interviews first you will see a brief assessment then you will see a contextual assessment notice how different the interviews are and what different information a clinician can get from asking a client about his day in detail while you are watching the interviews can you assess the client's stage of treatment can you make a list of cues and consequences of substance use for the client what about tobacco I smoke two packs a day two packs
a day okay what about caffeine uh about three cups a day okay um do you ever have you ever used heroin no um LSD yes I was on LSD when I get shot you were okay um I did it twice that's it yeah how about uh speed yeah crystal meth Crystal math okay and um when you use cocaine how did you use it did you snort it did you it used it I intervenous yeah yeah Crystal mess how did you use that I drink it with coffee okay because you get more kick with a caffeine
with a coffee and you drink it yeah get a real boost yeah um you're currently drinking yeah yeah how old were you when you started to drink 12 okay and how much are you drinking today when I drink I drink about two six packs okay two six packs in the day or in the evening or a day a day is that pretty much your usual amount yeah is there any a Time Steve when you could drink more sometime yeah your case okay do you ever have blackouts when you drink sometime I forget when I go
to bed okay you mentioned the last day you drank was two days ago yeah why don't you take me through that day with you tell me what you did that day starting from in the morning when you got up when when I get up I just well I lay in bed for a long time you lay in bed for a long time and my buddy came over your buddy came over and he wanted to get some beers so he came in and you were still in bed no I get up oh you were up I
get up what time was it when he came over about uh noon time noon time and what does he do does he walk right in or how no he KN at the door my wife answer at the door wife is there and he wanted to drink what did he say he feel like getting some beers he said I feel like getting some beers yeah say that to you or your wife or to me uhhuh and what were you thinking and what did you say I said yes what were you thinking get a buzz on I'm
sorry getting a buzz on getting a buzz on you were thinking can't feeling good getting feeling good yeah huh how are you feeling when he said let's let's get some beers a little bit anxious you're feeling a little anxious yeah tell me about that like my anxiety goes up it does tell me more about your anxiety going up goes up like um before I start drinking my anxiety goes up goes up more but when I start drinking it goes down H then when I come off the alcohol it goes up so it goes up before
you drink you drink and it goes down and after you drink it goes back up how long after you drink does it go back up and you hallucinate yeah how long after you stop drinking does it take before it goes up excuse me how long after you stop drinking before your anxiety goes up again after I uh come down okay well let's go back to the this day a couple days ago your buddy comes over says let's go get some beers and you're thinking let's put a buzz on um and you said what did you
say to him I said yes yeah so then what happened he went to the store he went to the store and what were you I get paranoid I don't know if he goes to the store you get paranoid so you don't go to the store so where were you home you stayed home where was your wife home mhm did she say anything about going to get beers no what was she up she had a couple too she had a couple to so your buddy went to the store what were what did you guys do while
he went to the store just sat around listen to the radio M what were you thinking about forget you forget yeah were you thinking about when he was going to come back with the beers or were you just doing other stuff well this was to idea waiting for me to get back okay and do you remember what you were feeling like were you having any of that anxiety you were mentioning before or were you feeling calm or paranoia paranoia tell me about that you see I have uh hallucination sometime and I see um faces on
uh walls you feel paranoia and you see faces on walls tell me more about the paranoia just uh people out to get me people are out to get you yeah H tell me more that's about it any particular people I think there's conspiracies against me oh there's conspiracies yeah that can happen what what's the conspiracy against you but this want to get me they want to get you there's a conspiracy about that yeah were you thinking about that that day two days ago I forget you forget okay okay I think about that a lot you
think about that a lot yeah every day not every day not every day no okay what's it like when you think about that I just don't I don't feel good I get paranoid you don't feel good you get paranoid yeah yeah it doesn't sound fun I have a hard time sleeping because of that too you have a hard time sleeping because of that yeah that's hard back to that day I think we left off where your friend went out to get beers and you were hanging around at home listening to music with your wife when
did he come back about 10 minutes about 10 minutes then what happened we deci we started drinking you started drinking yeah how do you drink I just think bad Wiis Old Milwaukee Old Milwaukee cans or bottles cans yeah yeah and where do you drink in the kitchen in the kitchen yeah was everybody there was only us three us you three okay what do you do while you're drinking just casual talk casual talk what's that like nothing is talking talking Off the Wall yeah yeah yeah is that fun what's this confers confers just conversations yeah yeah
yeah it sounds like it's kind of nice being with your friend and your wife and having conversations is that right that it's kind of nice yeah yeah but when it come down to alcohol I don't like it you don't why not the anxiety picks up more my paranoia picks up more it does yeah huh did it happen that day when you were sitting in the kitchen drinking was it Old Milwaukee that day yeah tell me about what it was like that day I started hallucinating a little bit more you did that day yeah what were
you seeing faces on WS you were what did you do try toy to ignore it you what try to ignore you tried to ignore it okay at what point did that happen around what time I don't know it just happened had you finished your beer yet no it started before you even finished your beer yeah okay you ignored it okay then what happened I just drank Dr of the beers and I uh went to bed how many beers did you drink we we split three six packs split split three six packs yeah how long did
it take for you to get through three six packs together couple of hours couple hours yeah and were you chatting the whole time talking no no no what were what else did you do then we went into a living room and we uh watch TV you watch TV yeah which I just space out I don't even know what's going on on the TV set I see and are you drinking while you're watching TV spacing out yeah okay and while you're spacing out is there something else on your mind what's going on inside when you're spacing
out still conspiracies you thinking about the conspiracies yeah I see and what I think about that a lot yeah you think about that a lot so you're sitting in the living room drinking beer watching TV or they're watching TV but you're thinking about the conspiracies how do you feel when you're drinking beer and thinking about conspiracies lousy lousy in what way cuz I think people out to get me oh and I don't like that you know it doesn't sound like fun yeah how many beers do you think you ended up having out of those three
six packs while you're sitting and drinking and thinking about conspiracies prob about seven about seven and how did that feel the seven beers for you after that after it helped me relax and I went to bed okay how long did it take for you to fall asleep probably about 3 hours three hours okay huh so for that day can I just summarize and you can add in anything that I missed sounds like you get up and you stay home friends come over and then you drink with a friend and your wife and then when that's
over you just go over to bed not much going on besides drinking that day is that right anything else happened that day besides the drinking no no is that day usual for you or was that an unusual kind of day usual that's usual okay that's why I want to get an alcohol counselor why to help me stop drinking why do you want to stop cuz I don't want to die you don't want to die that's a good reason
