Advanced Diagnostic Testing and Assessment: Integrating Interdisciplinary Approaches for Accurate Diagnoses
As the prevalence of substance and its effects continue to impact people and their families, it is important to understand all facets of the client’s condition. In 2022, over 48 million Americans were diagnosed with a substance use disorder.
One of the most prevalent conditions we face is a co-occurring mental health condition presenting with a substance use disorder. The goal of advanced diagnostic testing is to inquire about all possibilities of condition presentation: did psychosis occur from substance use or an underlying mental health condition? In this report, we discuss the significance of interdisciplinary approaches for accurate diagnoses and Alta Mira’s integral processes.
Comprehensive Assessment and Testing in Drug Rehabilitation
To accurately diagnose a client with a substance use disorder (SUD) that co-occurs with another mental health condition, comprehensive and extensive testing is essential. The demand for individualized medical treatments has increased across all healthcare sectors, including addiction medicine. This demand has driven the pursuit of effective diagnostic methods to ensure precise and reliable evaluations.
Research shows that substance use disorder is a serious condition that incorporates genetic, and neural maturation, with cultural and societal elements. These multidimensional aspects must be thoroughly considered during treatment to deliver optimal recovery outcomes.
One approach to achieving accurate diagnoses involves matching comprehensive need-service assessments to the client’s specific circumstances. Studies demonstrate that such tailored assessments lead to improved outcomes in primary and overall substance use over the subsequent year. Key areas of focus in these assessments include mental health, housing, medical care, family dynamics, and vocational support. At Alta Mira, this approach is enhanced by integrating physical, neurological, behavioral, and psychological evaluations; followed by continuous observation throughout the treatment process.
Dr. Laura Natta, a clinical psychologist and director of neuropsychological assessment at Alta Mira, shares how the process begins during client intake:
At Alta Mira, we use assessment for a few different things. The first would be to see how the patient is doing. The second would be to inform treatment. For instance, there are certain types of treatment that go with certain cognitive profiles. If you have a patient with very low abstraction, for instance, they’ll never be able to effectively do cognitive behavioral therapy. So, the second way is to sort of guide the team in how to best treat the patient.
The third is a very close collaboration that I have with the psychiatry and internal medicine departments. It sort of guides the medication management for the patient. The fourth would be to affect the aftercare planning. If a patient is having a problem multitasking, for instance, and we give them a list of 17 things they have to do upon discharge, they’re never going to get [any of it] done.
If we didn’t do the assessment, we would miss the various ways in which cognition, personality, and emotional functioning influence your overall picture and recovery. If we didn’t do the assessment, we would run the risk of missing an accurate diagnosis, which is the first step towards successful treatment. Also, we run the risk of assuming that a patient either cannot or will not engage in treatment, and that’s a risk you really can’t take. (Alta Mira – How Assessment Informs Treatment – Laura Natta, PhD)
Physical Testing
The initial physical testing begins with a comprehensive assessment of the client’s well-being. Clinicians first evaluate whether the individual is experiencing a psychotic episode or has physical deformities related to chronic substance use. These critical aspects are addressed immediately upon intake to establish a baseline understanding of the client’s condition.
The second component involves a thorough biological workup, including a complete blood panel, which rules out underlying medical conditions that may contribute to the client’s symptoms. Psychosis, for example, is not solely linked to substance use. Medical conditions such as Cushing’s disease, lupus, meningitis, and dementia are also known to induce psychotic episodes. Clients living with any of these conditions while using substances experience an aggravation of their psychosis. Blood tests are therefore essential for identifying the presence of such conditions.
Substance use contributes to a range of adverse physical health effects, including heart disease, cancer, and chronic obstructive pulmonary disease (COPD), among others. Proper diagnosis of these conditions necessitates advanced medical imaging techniques such as magnetic resonance imaging (MRI), computerized axial tomography (CAT) scans, and positron emission tomography (PET) scans, which provide the necessary data to confirm the presence and extent of these health issues.
By conducting these medical tests, clinicians determine whether underlying physical conditions are the primary cause of mental health disturbances, a contributing factor, or not a concern. This comprehensive approach is essential for accurate diagnosis, as it clarifies the connection between physical health and mental health, particularly in substance use disorders. Understanding how physical conditions influence mental health symptoms and the progression of substance use disorders is critical. With this knowledge, clinicians develop effective, individualized treatment plans that address both the physical and psychological dimensions of the client’s condition.
Psychological Assessments
Dr. Helen “Py” Driscoll M.D., an addiction and internal medicine physician consultant at Alta Mira, discusses the initial psychological cases she has seen:
Most of our patients are more complicated psychiatrically than they are medically. Patients come in and they really are not in reality, they have a clear thought disorder. They’re not able to have a normal conversation. This usually happens in three different ways. One is purely a substance-induced psychosis. One is where a patient would have become psychotic at some point, but their substances triggered it early. And some patients are just having a new psychotic break independent of their substance use. (Dr. Helen “Py” Driscoll M.D.)
Clients presenting with substance-induced psychosis, among other complications, require comprehensive psychological assessments following stabilization. One of the primary diagnostic tools employed is the Structured Clinical Interview for DSM-5 (SCID-5), a series of interviews designed to assess a range of psychiatric disorders, including mood, personality, psychotic, and substance use disorders. This structured approach ensures a systematic and reliable diagnosis across multiple domains.
In addition to the SCID-5, the Mini-International Neuropsychiatric Interview (M.I.N.I.) is often utilized as a rapid screening tool. This interview is designed to be concise, typically lasting about 15 minutes, and provide an efficient way to identify key psychiatric conditions, making it a valuable complement to more extensive diagnostic evaluations.
One of the most widely used psychometric tools for assessing personality traits and psychopathology is The Minnesota Multiphasic Personality Inventory (MMPI). It provides a comprehensive evaluation of psychological conditions, allowing clinicians to draw inferences about the presence of psychopathy or other psychological disorders. Additionally, the data obtained from the MMPI can be used to compare an individual’s psychological characteristics against normative benchmarks, offering valuable insights into deviations from typical personality patterns and mental health profiles.
Alta Mira incorporates these advanced assessments as an integral component of its comprehensive treatment process. Using these diagnostic tools ensures accurate and precise psychological evaluations, facilitating tailored and effective therapeutic interventions.
Neuropsychological and Cognitive Procedures
Dr. Laura Natta has this to say about neuropsychological testing and co-occurring disorders:
I honestly don’t think that people have substance use disorders without a co-occurring disorder. We very rarely see anybody where the entire treatment team goes ‘Oh yeah, it’s just alcohol’ or ‘It’s just methamphetamines.’ There’s usually another actual co-occurring disorder that has to be treated at the same time, and being able to properly diagnose that other underlying disorder means that the treatment team will be able to treat that and provide that patient with true recovery down the line.
We had a 32-year-old Caucasian male present with cocaine use disorder, and he had done so much cocaine that he had done physical damage to his sinus cavities. And in treating him, we found that this same person who originally came in and said, ‘Oh there’s nothing else wrong with me, I’m perfectly fine,’ actually had a very deep-set depression and he was actually self-medicating with cocaine. In his mind, he wasn’t doing that, but we found out as a treatment team he was doing that. So, it was really important to be able to classify what type of depression this was and the etiology of that and treat the depression at the same time that we were treating the cocaine use disorder. So that he could really and truly get better instead of just patching something and going on. (Co-Occurring Disorders – Laura Natta, Ph.D.)
Dr. Latta also emphasizes the importance of cognitive function testing in determining the most appropriate therapeutic approaches for each client. Commonly used cognitive assessments include the Wechsler Adult Intelligence Scale (WAIS), the Wechsler Memory Scale, and the Wechsler Fundamentals: Academic Skills examinations. These tests possess strong psychometric properties, making them reliable tools for detecting neuropsychological deficits. By evaluating distinct intellectual domains, such as memory, reasoning, and academic abilities, clinicians gain a complete understanding of a client’s cognitive profile, including an overall intelligence quotient (IQ) score. This insight allows for tailored treatment plans that address the client’s unique cognitive strengths and challenges.
These assessments provide valuable insights into the neuropsychological functioning of the brain, particularly in how psychoactive substances such as alcohol, cannabis, opioids, and stimulants risk altering both brain structure and function. These substances cause significant changes in cognitive processes, and neuropsychological testing detects the extent of these alterations.
A study comparing the effects of these psychoactive substances on cognitive impairment revealed that 31% of participants experienced a level of cognitive damage. These findings underscore the importance of early detection of cognitive impairment in individuals with substance use disorders. Early assessment allows for the implementation of tailored treatment protocols, improving outcomes by addressing the cognitive deficits that substances may cause.
The Importance of Ongoing Observation
Test results necessitate follow-up care as the treatment regimen begins, primarily because both physical and mental health statuses can evolve once substances are eliminated from the body. Clients presenting with psychosis, for instance, may later reveal underlying mental health conditions such as bipolar disorder or schizophrenia as the detoxification process concludes. This shift in diagnosis can significantly alter the course of treatment. Or, if there was only a mental health isolated incident resulting solely from substance use, the focus may shift toward an intensive and targeted substance use disorder treatment.
Addressing co-occurring disorders is vital to the overall treatment process. Ongoing observation and reassessment are necessary to tailor the treatment plan accurately, ensuring that both the substance use disorder and any underlying psychiatric conditions are treated concurrently and effectively.
Multidisciplinary Assessments Enable Individualized Care in Treatment
A multidisciplinary approach to assessment plays a pivotal role in shaping individualized care within the context of substance use disorder treatment and co-occurring mental health conditions. Assessments encompassing physical, neurological, psychological, and behavioral testing provide a detailed understanding of the client’s unique medical and mental health profile. These results help our clinicians identify underlying physical conditions, assess cognitive function, and detect any neuropsychological deficits influencing the course of treatment that are missed by other treatment programs.
Medical tests reveal whether physical health conditions contribute to the client’s mental health symptoms or whether cognitive impairments have been exacerbated by substance use. Such findings guide the formulation of treatment plans, ensuring that physical and psychological conditions are addressed in the proper order. For example, a patient with cognitive deficiencies won’t benefit significantly from psychotherapeutic interventions. In this case, the cognitive deficiencies need to be addressed first, then therapy can be utilized to further improve outcomes.
Assessments are not just part of the initial treatment plan. At Alta Mira, we engage in ongoing testing, which allows for the monitoring of changes in the client’s mental and physical health status as substances leave their system or as new medications are prescribed. Changes resulting from initial interventions can significantly alter diagnoses and treatment needs, requiring adjustment to individualized treatment protocols.
Assessment results are crucial in informing an integrated treatment approach when co-occurring disorders are present. By tailoring interventions based on the individual’s needs, including adjustments in therapy types, medication management, and social support services, clinicians are better equipped to treat mental health disorders and substance use disorders simultaneously. The accurate interpretation and application of testing results lead to more personalized, effective care, improving treatment outcomes and long-term recovery success.
Collaborative Dynamics of Interdisciplinary Teams
Assessments alone are not enough. Mental health and substance use disorders, especially regarding the complexities of dual diagnosis treatment, are rarely black or white. Collaboration between experts in each field is essential to determine effective treatment paths and outcomes. At Alta Mira, multidisciplinary specialists from physical health, mental health, neurology, and social support work together to provide comprehensive care. By integrating results across these areas, the team addresses both mental health and physical health conditions simultaneously, leading to higher success rates in treating substance use disorders. Each professional involved, including medical physicians, psychiatrists, therapists, and support staff, plays a critical role throughout the treatment process. They contribute their expertise to create an evidence-based, individualized care plan that addresses all aspects of the client’s well-being.
The Alta Mira Difference: Integrated Care Across All Specialties
Advanced diagnostic testing across all specialties provides an accurate diagnosis involving physical and mental health in co-occurring substance use disorders. By identifying these conditions, proper treatment is administered, increasing the success of recovery outcomes. Clients don’t realize all of the effects that substances are causing, furthering the need to increase the types of tests performed. Alta Mira offers these services to all clients, ensuring no gaps occur in the treatment process.
If you need a referral source for substance use disorder clients or are looking for treatment options on your own, Alta Mira’s approach is the next step. Underlying mental and physical health conditions need to be addressed and treated at the same time as substance use disorder to create success in recovery. Our team of experts integrates evidence-based treatment modalities and holistic approaches to provide the highest level of care available. Contact us today at 866-922-1350 to learn more about our program offerings.
Alta Mira: Science-backed treatment, world-class care
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