Addiction Severity Index ASI Treatnet Training Volume A

Addiction Severity Index (ASI) Treatnet Training Volume A, Module 2, Workshop 4 - Updated: 1 January, 2007 The Addiction Severity Index

Treatnet ASI Workshop 4 The ASI: Administering and Coding Psychiatric Section Review Competency Measures The Addiction Severity Index 2

Transition to Psychiatric Section The Addiction Severity Index

Psychiatric Section This Section is used to determine symptoms of psychological and emotional distress; not provide a diagnosis. l Symptoms associated exclusively with results of ingesting a drug (i. e. hallucinating on acid) or detoxification (I’m anxious when I detox) should not be recorded. l The Addiction Severity Index 4

Psychiatric Section: Intent l To determine long term and recent psychological and emotional functioning l Document current and past history of treatment l To explore the potential for the need for further evaluation or referral Mood disorders l Anxiety disorders l Thought disorders, etc. l The Addiction Severity Index 5

P 1–P 2: Prior Psychological Treatment l Include treatment for any psychiatric problems, DO NOT include substance abuse, employment, or family counseling. The Addiction Severity Index 6

P 3: Financial Support for Psych Disability l Coding Issues: Only record pensions received for psychological disorders/disabilities; pensions for disorders such as a heart condition should be recorded in the Medical Section l If a client does not know the disorder for which he/she receives the pension, code ‘X’ The Addiction Severity Index 7

P 4 – P 7: Psychological Symptoms The Addiction Severity Index 8

P 4 – P 7: Psychological Symptoms Describe the symptoms l Ask about serious symptoms over lifetime first, then ask l Lifetime coding symptom > 2 weeks. l Note: P 6 is of sufficient importance that even its brief existence should be recorded l Past 30 days code “ 1 -yes” if the client has experienced the symptom at all l Code other psychotic symptoms in P 6. l The Addiction Severity Index 9

P 8 Psychological Symptoms l Coding Issues: l Due to the severity of the symptom code even if it happened only once in the lifetime section l Further, code even if the patient was under the influence of drugs and/or alcohol, or suffering from withdrawal at the time of the symptom. The Addiction Severity Index 10

P 9 & P 10: Suicidal Ideology l If a client endorses serious thoughts of suicide: l Ask how recently the client has seriously considered suicide, or attempted suicide l Ask details of the suicide plan (i. e. “How were you going to commit suicide? ”) The Addiction Severity Index 11

P 11: Prescription Medications l Don’t include temporary medications l Emphasize “prescribed for you” The Addiction Severity Index 12

P 12 – Days of Problems Note: Use the symptom the patient reports having problems with, not simply the term “psychological problems” For example: “Mr. Smith, you mentioned that you were experiencing depression, could you tell me how many days in the past 30 days you felt depressed? ” The Addiction Severity Index 13

The Final 3 - Psychiatric l P 12 “How many days in the past 30 have you experienced these psychological or emotional problems? ” l P 13 “How much have you been troubled or bothered by these psychological or emotional problems in the past 30 days? ” l P 14 “How important to you now is treatment for these psychological or emotional problems”? The Addiction Severity Index 14

Patient/Client Rating Scale PATIENT/CLIENT RATING SCALE 0 1 2 3 4 NOT AT ALL SLIGHTLY MODERATELY CONSIDERABLY EXTREMELY The Addiction Severity Index 15

P 12 – P 14: “Psych Final 3” l P 12 refers to symptoms mentioned in P 4 -P 10 l P 12 must be >0 if any past 30 day item in P 4 -P 10 > 0. The Addiction Severity Index 16

P 12 – P 14: “Psych Final 3” For P 14, address that “treatment” does not necessarily mean going to a psychiatric ward, or being put on medication. The Addiction Severity Index 17

Final 3 Scoring - Psychiatric If P 12 = 0, then P 13 = 0 and P 14 should be 0 If P 12 > 0, then P 13 > 0, and P 14 can be any number The Addiction Severity Index 18

P 22 & P 23: Confidence Ratings l Did the client overtly give false information that you caught and asked about? l Did the client cognitively understand your questions? The Addiction Severity Index 19

G 12: “Special Codes” Code “ 1” if the interviewer terminated the session for any reason (e. g. feeling threatened by client) Code “ 2” if the client refused to complete the interview Code “N” if the interview was completed The Addiction Severity Index 20

G 50: Expected Treatment Modality G 50. Expected Treatment Modality: 1=Outpatient (<5 hours per week) 2=Intensive Outpatient (≥ 5 hours per week) 3=Residential/Inpatient 4=Therapeutic Community 5=Half-way house 6=Detox – Inpatient (typically 3 – 7 days) 7=Detox Outpatient/Ambulatory 8=Opioid Replacement, OP (Methadone, Buprenorphine, etc) 9=Other (low threshold, GP, spiritual healers, etc. ) Specify______________________ The Addiction Severity Index 21

Wrap-up Interview l Importance of wrap-up l Acknowledge client’s time & work l Summarize strengths, assets and discuss treatment needs l Client’s next steps… The Addiction Severity Index 22

Finalize the ASI l. Review ASI for completeness l. Leave no empty boxes. l. Add additional comments. The Addiction Severity Index 23

Questions? Comments? The Addiction Severity Index 24