Healthcare Professional Consideration: It is important to note that it is unwise for a healthcare professional to rely solely on data from screening tool diagnoses and treatment plans. It is best to supplement information obtained through standardized instruments with other assessment data, such as psychosocial assessments, mental status examinations, collateral reports (from family, peers, teachers, therapists, physicians, probation officers, or clergy, if indicated), and direct observation. Multidimensional Assessment Data Assessment data provide the material for an evaluation of the adolescent’s weaknesses, strengths, problems, and needs. This information should be used to create a treatment plan. All assessments and treatment plans must be evaluated regularly throughout the course of treatment. ● Some areas that should be addressed in the assessment process include the following (Meadows-Oliver, 2019; Videbeck, 2020). ● Complete medical and psychiatric health history ● Psychological and emotional functioning ● Mental status examination ● History of chemical use or abuse ● Chief complaint ● Treatment history for mental and physical conditions ● Psychological tests ● Age ● Assigned gender, gender identity, and sexual orientation ● Family background and functioning ● Cultural identification ● Education and work history ● Socioeconomic status ● Legal involvement history ● Community resources ● Strengths, weaknesses, problems, and needs Many adolescents who present for substance use treatment may also have other diagnoses, such as conduct disorder, anxiety disorders, trauma- and stressor-related disorders, bipolar and related disorders, depressive disorders, attention-deficit/hyperactivity disorder, or oppositional defiant disorder. For example, many substance-using adolescents exhibit symptoms of bipolar and related disorders; substance use may represent these adolescents’ Physical Illnesses Several physical illnesses are public health concerns for both patients and healthcare professionals in SUD treatment programs. These include HIV, AIDS, and viral hepatitis. HIV infection prevention and reduced infection rates are central goals in SUD treatment programs. Research indicates that HIV testing and risk-reduction interventions are linked to cessation or reduction of drug use as well as associated high-risk behaviors, such as unsafe sex (SAMHSA, 2020). HIV/AIDS HIV can be contracted when someone comes into contact with the body fluids of an infected person. Having unprotected sex and sharing needles when participating in injection drug use are examples of methods of HIV transmission. If women are infected and are not treated, they can pass HIV to their infants during pregnancy, delivery, and lactation. Alcohol and drug misuse can exacerbate symptoms of HIV (SAMHSA, 2020).
● History of sexual, physical, and/or emotional abuse (as victim and/or perpetrator) ● History of traumatic events ● Behavioral definitions of problems related to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), criteria (APA, 2013). Drug screening may also be implicated in cases related to criminal activity, legal jeopardy, and/or physical and/ or emotional abuse. If patients are implicated in the juvenile court system, they must be given a thorough evaluation for substance use problems, physical disorders, mental disorders, school performance, sexual abuse accounts, and other comorbid conditions. It is difficult to achieve successful outcomes with an adolescent under these circumstances unless they are removed from their pathological environment. Immediate intervention is critical when working with youth who are involved in the juvenile court system (Guerrero et al., 2015).
Healthcare Professional Consideration: It is imperative for assessment to incorporate physical, cognitive, social, and emotional domain indicators. Without consideration of all facets of an adolescent’s life, a complete and useful assessment cannot be conducted COEXISTING DISORDERS IN AN ADOLESCENT PATIENT WITH A SUBSTANCE USE DISORDER
attempt to self-medicate for their symptoms. The high prevalence rates for co-occurring diagnoses in adolescents have led some researchers to note that dually diagnosed adolescents are not a special subpopulation but are instead the norm (Yoshimasu et al., 2016). Thus, an important aspect of working with adolescents relates to the diagnosis of coexisting disorders. Evidence-Based Practice In 2019 in the U.S., people who injected drugs accounted for 7% (2,508) of the 36,801 new HIV diagnoses. Men who injected drugs accounted for 4% (1,397) of the new HIV diagnoses. Women who injected drugs accounted for 3% (1,111) of the new HIV diagnoses (CDC, 2021c). Hepatitis The three key strains of viral hepatitis infection are hepatitis A, hepatitis B, and hepatitis C. Vaccines are available for hepatitis A and hepatitis B. Currently, there is no vaccine available for hepatitis C. The primary source of hepatitis C infection in the U.S. is injection drug use. Injection drug use is a significant risk factor for contracting and spreading hepatitis C (SAMHSA, 2020). Although most hepatitis C infections occur via exposure to blood from unsafe injection practices and drug use, there are additional major causes, including unsafe healthcare practices, unscreened blood transfusions, and sexual practices that lead to blood exposure (World Health Organization [WHO], 2019.
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