Debra Guthmann, Ed.D., and co-authored by Katherine A. Sandberg,
B.A., C.C.D.C.R.
Abstract
School counselors who provide
services to Deaf and hard of hearing students may encounter
situations that could be related to the young person's use
of alcohol and/or other drugs. Locating an agency that can
provide an appropriate chemical dependency assessment for
a Deaf or hard of hearing person is difficult since there
are no formalized assessment tools normed or specifically
designed to use with Deaf and hard of hearing individuals.
Additionally, most assessors are unfamiliar with how to work
with Deaf and hard of hearing people, less likely to be fluent
in American Sign Language and unaware of appropriate treatment
options. The purpose of this article is to provide an overview
of chemical dependency, assessment issues and considerations
unique to this population. A chemical dependency assessment
tool developed by the Minnesota Chemical Dependency Program
for Deaf and Hard of Hearing Individuals is described as well
as a case study of a young man that will assist with the application
of the assessment process.
Introduction
School counselors and other professionals who
provide services to deaf and hard of hearing students should
be aware of the potential problems of alcohol and other drug
abuse.
It is estimated that 9.6 percent of men and
3.2 percent of women in the United States will become alcohol
dependent at some time in their lives(Grant, 1992); many more
men and women will exhibit drinking behavior that can be classified
as alcohol abuse. According to the 1992 National Household
Survey on Drug Abuse, more than 74 million Americans have
used alcohol/drugs and this use can interfere with daily living,
relationships, and the health of the user. Addiction to alcohol
and or other drugs is found in every class and group of people
in the United States including Deaf and hard of hearing people.
How does one know if someone is an alcoholic and or drug addict?
Can a teenager be addicted? If someone only drinks on the
weekend are they an alcoholic? It is imperative that professionals
who work with Deaf and hard of hearing individuals be familiar
with how to identify the basic signs and symptoms of alcohol
and drug abuse. This article will provide a basic overview
of chemical dependency, symptoms of substance abuse and a
case study outlining assessment issues.
Chemical Use, Abuse and Dependency
An important place to begin is by understanding
what is meant by the term chemical dependency. Chemical
dependency can be defined as the continued use of mood altering
chemicals, despite suffering harmful consequences and marked
by the inability to stop using. It is a primary love relationship
with alcohol or another drug that systematically changes the
way a person thinks, feels and behaves. For a person who is
dependent, using alcohol/drugs becomes more important than
interpersonal relationships, performance at school or work,
physical health, planning for the future, or anything else.
When drinking and/or using drugs are causing problems in a
persons life and the individual continues to drink or
use in spite of the problems, then that person has a problem
with drugs and alcohol.
There is substantial evidence that chemical
dependency can be accurately described as a disease. In fact,
"The American Medical Association, American Psychiatric
Association, American Public Health Association, American
Hospital Association of Social Workers, World Health Organization,
and the American College of Physicians have now each and all
officially pronounced alcoholism as a disease (Valiant, 1983).
In April of 1987, the American Medical Society on Alcoholism
and other Drug Dependencies ( whose membership includes over
2,000 M.D.s certified as specialists in chemical dependency)
officially declared that what is true for alcoholism is also
true for addiction to other drugs (Schaefer, 1996).
Chemical Dependency is a primary disease
meaning that it is not just a symptom of some other underlying
physical or emotional disorder. Instead, it causes many such
disorders. This means that many other problems a chemically
dependent person may have - such as physical illness, disturbed
family relationships, depression, unresolved grief issues
and trouble at school or on the job - cannot be treated effectively
until the person stops using chemicals. The dependency must
be treated first.
Chemical Dependency is a progressive
disease and once a person enters the addiction process, the
disease follows a predicable progressive course of symptoms.
Left untreated, it always gets worse. The progression typically
starts with a person using chemicals with few consequences
and moves to the use of chemicals with more serious consequences.
Typically, the addictive process happens more quickly with
young people who begin using alcohol and other drugs.
Chemical Dependency is a chronic disease.
This means that there is no cure for this condition. In this
respect, chemical dependency is similar to diabetes, another
chronic disease. In both cases, an individual can have a healthy,
happy, and productive life as long as he or she accepts the
need for a program of recovery. For the chemically dependent
person, this means no use of mood-altering chemicals and other
changes in ones lifestyle. Chemical dependency is a
lifelong disease with effective treatment, but no cure. This
makes it particularly challenging to work with young chemically
dependent deaf or hard of hearing people who often feel hopeless
when thinking of a lifetime of abstinence.
Chemical Dependency is a fatal disease.
A chemically dependent person ultimately dies prematurely
if he or she continues to use alcohol or other drugs. According
to Schaefer (1996), the average lifespan of an alcoholic is
10 to 12 years shorter than that of a non alcoholic. He also
states that alcoholics are 10 times more likely than non-alcoholics
to die from fires, 5 to 13 times more likely to die from falls
and 6 to 15 times more likely to commit suicide.
The four characteristics of chemical dependency
just described( primary, progressive, chronic and fatal) can
be discouraging for both the addicted person and others who
want to help. But, chemical dependency can be treated and
arrested. Schaefer (1996), indicates that seven out of ten
chemically dependent persons who accept treatment and use
the knowledge and tools they are given there find sobriety.
The Development of a Problem
Addiction develops over a period of time. Usually,
people begin to drink or use other drugs to have a good time.
Many young people report that they begin using mood altering
chemicals in response to peer pressure or to fit in better.
Some people also state they began using to "run away
from" problems in their live. Regardless of the reason
for beginning to use, the pattern of addiction consists of
four different stages which include: Use, Misuses, Abuse and
Dependency. 1.) Stage One - Use - A person uses alcohol
and or other drugs in a way that does not cause problems in
everyday life, for their family, for their friends or for
society(community); 2.) Stage Two - Misuse - A person
uses alcohol or other drugs and the alcohol and/or other drugs
causes problems for them. These problems can happen at home,
school or work and can involve the family, friends and/or
the police; 3.) Stage Three - Abuse - A person thinks
or feels that he/she needs the alcohol and/or other drugs
to feel good, to go to work or school, to solve problems,
to socialize with friends, etc.; 4.) Stage Four - Dependency(Addiction)
- A person needs to use alcohol and/or other drugs, just to
feel normal. These individuals have many problems but dont
see them. These individuals cannot stop their use of alcohol
and/or other drugs without some level of intervention.
The criteria used to diagnose chemical dependency
may include several or all of the following items: continued
use despite negative consequences, pathological use, loss
of control, use to extreme intoxication, blackouts, increased
tolerance, preoccupation with use, polydrug use, intoxication
throughout the day, repeated attempts to quit/control use,
binge use, solitary use, failure to meet obligations due to
use, use to medicate feelings, unplanned use, protecting supply,
changing friends, willingness to take increasing risk, morning
use or tremors.
The American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition
(DSM-IV) is widely used to "provide clear descriptions
of diagnostic categories in order to enable clinicians and
investigators to diagnose, communicate about, study and treat
people with various mental disorders" (DSM-IV, 1994,
p. xxvii). There is an entire section dealing with substance-related
disorders which presents diagnostic options for various substances
and for abuse or dependence. The DSM-IV criteria for alcohol
dependence include a maladaptive pattern of alcohol use; increased
tolerance; characteristic withdrawal symptoms; inability to
cut down or stop; giving up or reducing social occupational
or recreational activities because of drinking; time spent
focused on drinking or obtaining alcohol; and continued drinking
despite physical or psychological problems caused by the use
of alcohol. Diagnosis or assessment of a substance abuse problem
may happen in a variety of settings including a medical setting,
a substance abuse treatment program, a funding agency or a
mental health services provider.
Identifying a Problem
The purposes of chemical dependency assessment
are to evaluate an individual's strengths, problems, needs
and develop a treatment plan (CSAT-ASAM, 1995). While assessment
has always been an important aspect of appropriately serving
clients, the burgeoning of managed care systems, with conservative
approaches to placing people in treatment, make accurate assessment
even more crucial.
When assessing the extent of an individuals
chemical use the quantity of chemicals used should not be
the sole basis for a diagnosis. The quality of use also provides
helpful indicators of dependency. The development of increased
tolerance or the presence of withdrawal symptoms are considered
indicators of dependence. The concept of loss of control is
also recognized as significant in assessing chemical dependency.
The individual who uses more than planned or violates his/her
own limits for use may be experiencing a loss of control.
As previously mentioned, another factor considered to indicate
dependency is the continued use of mood altering chemicals
despite knowledge of negative consequences. Individuals who
seek to resolve their problems through the use of alcohol
and other drugs end up with even more problems because of
their use.
For diagnostic purposes, many agencies that
work with Deaf and hearing individuals will develop their
own assessment protocols, which seek to eliminate the communication
barriers inherent in diagnostic tools developed for use with
hearing people. Agencies may also modify existing tools or
protocols to accommodate the communication and cultural features
of the deaf person. The following elements, consistent with
the biopsychosocial perspective, should be included in an
assessment: medical examination, alcohol and drug use history,
psychosocial evaluation, psychiatric evaluation (where warranted),
review of socioeconomic factors, review of eligibility for
public health, welfare, employment and educational assistance
programs" (CSAT, 1995, p. 66).
Signs and Symptoms in Life Areas
One way of assessing the impact alcohol and
other drugs have on a person's life is to consider the consequences
of that use in various life areas. These life areas may include
school/employment, family, social physical, legal, spiritual,
financial and the impact that substance abuse has had on each
area. Generally, the primary difference in assessing Deaf
and hard of hearing individuals as compared to the assessment
of hearing people relates to communication issues. Unfortunately,
there are currently no formalized assessment tools specifically
designed for use with Deaf persons. Many agencies that serve
hearing people will attempt to use standardized assessment
tools such as the M.A.S.T. (Michigan Alcohol Screening Tool)
to assess a Deaf person. This kind of assessment is inappropriate
to use with many Deaf clients because of the vocabulary and
language level of the instrument. Programs serving Deaf people
have also developed their own systems or modified existing
instruments normed on hearing people. Perhaps more crucial
than the assessment tool or form is the manner in which the
assessment interview is conducted. It is crucial that the
interviewer take into account the possibility of lack of knowledge
of terminology and other communication and cultural factors.
The process typically incorporates a structured interview
model focusing on major life areas. The following are some
of the consequences commonly seen in the respective life areas:
Physical
frequent, unexplained illness
sudden weight loss or gain
injuries (from fight, accidents)
generally unhealthy appearance
unusual sinus or dental problems
memory loss (blackouts), hangovers
Family
fights, disagreements (about use)
neglect of responsibilities
failure to attend family functions
lack of trust
separation/divorce
loss of custody of children
Legal
DWI or DUI charges
probation violations
restraining orders
legal fines
court appearances
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Financial
overdue bills
banking problems
borrowing/stealing money
owing money to others
gambling activity
unexplained sources of income
Work/School
unexplained absences
pattern of absences/tardiness
inconsistent/declining performance
under the influence of chemicals
problems with teachers/students
discipline in job/school
Social
isolation, lack of friends
changing friends
socialization centered on use
friends are older or younger
broken relationships
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These signs can help to detect a problem with
the use of alcohol or other drugs. One or even a few of these
symptoms alone is probably not significant but in combination,
they can point to difficulties. Changes in these life areas
that are not attributable to other causes may be significant
factors when considering whether or not a person has alcohol
or other drug use problem. These life areas help those attempting
to assess for potential alcohol or other drug use problems
a more complete picture of how chemical use has impacted the
individual's life as a whole.
It is important to reiterate that just because
an individual meets some of the above criteria does not necessarily
mean that the person is chemically dependent. An example of
this would be a case where a Deaf high school student was
coming to school late on a daily basis. Staff had also noticed
that the student's grades were dropping and he was not as
motivated in school. If you look at the above criteria, this
kind of behavior might be an indication of potential alcohol
and or drug use. In this example, as it turned out, the teenage
boy's father was working nights and they had gotten a new
big screen television with pay for view movies and other cable
options. The student was staying up all night watching television
and was not able to wake up on time to go to school or to
complete his homework. Once the family was able to resolve
the issue of no television access at night, the student's
attendance at school and grades improved. This points out
the importance of using the above information as a guide,
but collateral information becomes critical when attempting
to determine the need for chemical dependency treatment or
other interventions.
Communication Issues and Assessment
A common problem encountered when assessing
Deaf students involves the use of chemical dependency language
not familiar to the individual. For example, a typical question
may deal with the experience of a "blackout" which
is a significant diagnostic feature of chemical dependency.
(Blackout refers to a period of time in which the person is
awake and functioning but after which there is no recollection
of some or all of the events.) In assessing a Deaf client,
the interviewer may need to explain the phenomenon in addition
to (or instead of) using the term "blackout". The
interviewer who fails to explain concepts or vocabulary that
may be unfamiliar risks compromising the validity of the assessment.
Many students will not ask for an explanation or clarification
of terminology, but instead may respond to the question without
understanding it completely. Another common problem area is
related to the use of an interpreter for an assessor who is
not able to communicate directly with the Deaf client. The
addition of a third party will most likely change the dynamics
and possibly the validity of the interview session if the
interpreter is not fully qualified. The limited availability
of such interpreters is also a factor that continues to be
a problem throughout the United Sates. There are very few
interpreter training programs that focus on the specialized
substance abuse vocabulary necessary when assessing Deaf individuals.
Assessment of Problem Use
Knowing and recognizing potential signs of chemical
abuse is an important step in helping individuals who may
be experiencing problems. A significant aspect of chemical
dependency is the denial exhibited by the individual requiring
some kind of intervention. In the absence of outside feedback,
many people are able to rationalize, minimize and in others
ways deny the problem. Chemical use becomes such an integral
part of one's life that a person is unable to see the negative
effects or to attribute them to the use of the alcohol or
other drugs. While accusations about chemical use may lead
to even stronger denial, sharing of genuine concerns can be
an effective technique to help someone realize how their use
is having a negative impact. The use of "I" statements
and naming specific concerns or behaviors can be helpful.
For example, a counselor might say, " I notice you have
been missing a lot of classes.", or "I notice your
grades are dropping in several classes." "I care
about you and am concerned that you might need some help."
Such communication is less likely to raise the person's defenses
and lets them know that someone cares about them.
The Minnesota Chemical Dependency Program for
Deaf and Hard of Hearing Individuals(MCDPDHHI) has developed
an assessment tool that is useful in recording the information,
once the interview with the client has been completed (Appendix
A). When talking with a client, it is essential to maintain
eye contact and to elicit information from the person in a
non-judgmental manner. The manner in which questions are asked
can determine the effectiveness of the interview.
To assist in the application of the assessment
process, a case study is presented below followed by the completion
of an assessment questionnaire on Tim.
Case History - Tim
Presenting Problem: Tim
has been asked to see his school counselor by one of his teachers.
This teacher and several others have noticed that Tims
attendance has been inconsistent and that his performance
in his classes has slipped. He has stopped participating in
athletics, which used to be very important to him. He seems
to be alone much of the time and is rarely seen with his old
group of friends.
Background: Tim is the
only deaf child of hearing parents. He has two siblings, a
younger sister and an older brother. It appears that Tims
hearing loss has been present since birth and is of unknown
etiology. Tims parents divorced when he was 8 years
old. Tim continued to live with his siblings and his mother
after the divorce. Tims father does not sign at all;
Tims mother and brother have limited sign skills. Tims
sister signs well and seems to have a close relationship with
him. Tim rarely sees his father. Tim depends on American Sign
Language as his primary means of communication. Lately, Tim
and his mother have argued frequently, usually about Tims
failure to come home on time. Tims mother is concerned
because he seems different in some way.
School: Tim started school
in a pre-school program in his home town. He also attended
elementary school there with an interpreter for several hours
each day. Tim was successful academically during his elementary
school years and was involved with activities with his hearing
peers. In the 7th grade, Tim transferred to the School for
the Deaf. Initially, Tim participated in both school and extracurricular
activities. He was successful in the classroom and in various
sports. Over the past year and a half, teachers, dorm supervisors
and coaches began noticing changes in Tim. He began to have
attendance problems, sometimes coming back to school late
from weekends home, sometimes skipping a class or two during
the day. His grades began to decline and he dropped out of
football, basketball and finally baseball. Tim does not spend
much time with his old friends at the Deaf School, and in
fact, is alone at school much of the time. Staff have seen
him off campus with a group of hearing kids occasionally.
At this time, he is in danger of failing two of his classes.
At a recent conference held with Tim, his mother, the principal
and his counselor, Tim admitted that he has been using marijuana
and drinking beer on a regular basis at home and has no desire
to continue attending the deaf school. Tim doesnt think
he has a problem with his use and has no desire to stop at
this time.
Social: As mentioned above,
Tims group of friends has changed in the past year and
a half. The group of hearing people he has been seen with
appear to be several years older than Tim. Some of these hearing
friends have been kicked out of their high schools and attend
an alternative school. Tim has mentioned to several people
that he wants to leave the school for the Deaf so he can attend
the alternative school with his friends. Several of Tims
former friends at the school have commented to staff that
Tim has changed and that they dont have much contact
with him any more. A few weeks ago, Tim was involved in a
fight in the school cafeteria and staff were unable to get
a clear explanation of the reason for the fight.
Legal: Tim has had no
legal problems at school. He has been picked up for curfew
violations three times in the last 6 months when he has been
at home. No charges were filed.
Financial: Tims
mother provides him with spending money. He occasionally asks
her for additional money but it is unclear to staff how Tim
spends his money. Tims friends notice that he seems
to have a lot of money with him at times.
Family: Staff members
at the school have talked to Tims mother about his grades
and his lack of participation in other school activities.
Tims mom has tried talking to him about these issues
but both quickly become frustrated about the communication
problems. Tims mother is concerned but feels she has
little influence over him at this time. They have had a couple
of nasty arguments and Tim is sometimes gone all night when
he is home from school. His mother is unsure who he is with
when he is out.
Physical: Staff have noticed
that Tims appearance has changed lately. He use to be
clean cut and conscientious about his appearance. Recently,
he wears very baggy clothes, has bags under his eyes and wears
a stocking cap pulled down over his head and face. Tim has
had more frequent illnesses lately. Teachers at the school
report that he occasionally appears to be hung over. Tim reported
to a dorm supervisor that once, he had gone to a party over
the weekend and woke up at a friends house the next
morning and couldnt remember how he got there.
Tims substance abuse assessment
The assessment questionnaire
that the MCDPDHHI developed, can be used when meeting with
a Deaf or hard of hearing client that may have a drug and/or
alcohol problem. It is important to remember that this form
should only be used as a guide. When interviewing a Deaf or
hard of hearing person, eye contact is critical to the assessment
process. It is essential for the interviewer to become familiar
with the assessment questionnaire so that the person is not
looking down at the form and completing it while talking with
the client. While the intake or interview with the client
is in process, write down notes that can be later transferred
to the assessment form.
Substance Abuse
Assessment -Tim
Minnesota Chemical
Dependency Program for
Deaf and Hard
of Hearing Individuals
Client Name: ___Tim___________________
Date: 4-1-98_________
Assessor: _Ann
Jones___________________________________________________
Referred by: _School
Counselor_________ Agency: _School for the Deaf_____
Phone: 555-3333
Reason for Referral:
_______problems in school ________________________________________
Background
Information
Date of Birth: 3-28-81___
Age: ___17________ Gender: Male
Marital Status:
___Single _____ Living Arrangement: ___Lives w/
mother_______
School Status: _Junior
in H.S. __ Employment Status: ____student__________
Communication Preference:
_________________Sign language______________________________
Family Incidence
of Hearing Loss? YES / NO If yes, identify members: __Family
is hearing_________
Family Incidence
of alcohol/drug problems? YES If yes, identify members: ____Unknown__________
_____ ____________________________
Other background
information: __________Parents divorced when Tim was 8
years old_________
________ ________________________
Treatment History
Admissions for Detox:
Place __None reported______________ Dates __________________
Place ______________________________
Dates___________________
Admissions for Treatment:
Place __None
reported____________ Inpatient / Outpatient Dates ___________________
Place __________________________
Inpatient / Outpatient Dates ___________________
Place __________________________
Inpatient / Outpatient Dates ___________________
Longest
period of sobriety after treatment:____NA______
Most
recent period of sobriety: ____NA_______
Problems Related to Chemical Use
Physical Problems
__x__ Hangovers __
__ Tolerance _____ Withdrawal
__x__ Blackouts _____ Accidents/Injuries
__x___ Passing out
__x___ Fights _____ Injecting
drugs _____ Medicating pain
Comments:
Increased frequency of illnesses.
Financial Problems
____ Unpaid Bills ___X__ Borrowing
money _____ Outstanding loans
_____ Legal fines _____ Stealing
_____ Dealing
_____ Lifestyle change ____ Insufficient
income _____ Pawning items
Comments:
Seems to have a lot of money
at times....unsure of the source.
Family Problems
__x__ Arguments/fights ____ Abuse
_____ Broken promises
__x___ Absence from home _____
Loss of trust __X__ Concerns about use
____ Use by other members _____
Hiding drugs in home _____ Custody issues
Comments:
Legal Problems
_____ Arrests ____ Near arrests
_____ DWI/DUI
_____ Gang Involvement ____ Court
Appearances _____ Parole
_____ Restraining order _____
Domestic violence _____ Probation
Comments:
Tim has recently been picked
up for curfew violations.
Job / School Problems
__X__ Poor performance
__X__ Lateness __X__ Absences
_____ Problems with supervisor
_____ Fired/Suspended _____ Disciplined
__X__ Problems with peers
_____ Using at work/school
Comments:
Pattern of absences/lateness.
Declining performance.
Social Problems
__x___ Loss of friends
___x_ Change of friends ____ Friends use
____ Socialization around use
_____ Negative reputation _____ Gambling
__x___ Friends older /
younger
Comments:
Emotional Problems
____ Use to feel normal _____
Mood swings _____ Self harm
_____ Suicidal thoughts/behavior
____ Anger problems ____ Depression _____ Use to medicate
emotional pain
Comments:
Chemical Use Information
_____ Unplanned use ____ Binge
Use _____ Hidden use
_____ Using more than planned
____ Solo Use ____ Daily use
_____ Attempts to control use
_____ Relapse ____ Preoccupation
_____ Protecting Supply _____
Poly drug use
Comments:
Identify chemicals used.
For each chemical, identity age of first use & present
pattern of use.
__x__ Alcohol __x___ Marijuana
_____ Cocaine
_____ Crack _____ Inhalants _____
Sedatives
_____ Hallucinogens _____ Amphetamines
_____ Opiates
_____ Others: _____ Others: ______
Others:
Use information: ___________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
Diagnostic Features: Please check all
that apply.
____ TOLERANCE need for increase
amounts of substance to achieve intoxication or markedly diminished
effect with continued use of the same amount.
____ WITHDRAWAL characteristic
syndrome or same or closely related substance taken to relieve
or avoid withdrawal symptoms.
_____ SUBSTANCE taken in larger
amounts or over longer period than intended.
_____ PERSISTENT desire or unsuccessful
efforts to cut down or control use.
____ TIME spent in activities
necessary to obtain substance or recover from its use.
__x__ SOCIAL, OCCUPATIONAL ,
RECREATIONAL activities given up or reduced because of use.
____ CONTINUED use despite knowledge
of physical or psychological problems caused or exacerbated
by the use.
Interview Findings and Comments:
Conclusion
The information presented in this article and Tim's case
helps to illustrate key concepts of the assessment of substance
abuse problems. Those key concepts include the following:
- Alcohol and other drug use can negatively impact major
life areas.
- The progression of the disease involves the loss of control
over one's use and an increasing quality of unmanageability
in one's life.
- Chemical dependency includes an ever-increasing relationship
to the alcohol or drugs with a decreasing importance to
other relationships and aspects of one's life.
- Without treatment, consequences of one's use become increasingly
serious, leading ultimately to death.
For person's who are Deaf or hard of hearing, like Tim, the
principles of addiction and assessment are the same as they
are for hearing people. The process, however, must take into
account the communication factors mentioned above including
lack of familiarity with vocabulary, lack of assessors who
are skilled communicators with Deaf and hard of hearing individuals
and a lack of qualified interpreters able to facilitate communication
for a valid assessment.
The process of recovery begins by discovering the problem.
Only through appropriate and accurate assessments can Deaf
and hard of hearing people get the help they need to recover
from alcohol and other drug addiction.
Alcohol/Drug Programming
When providing drug/alcohol programming to students the following
components are essential to keep in mind; the cultural aspects
of deafness, communication modalities, access to recovering
deaf role models, access to deaf and/or interpreted AA/NA
meetings and materials that are available in ASL on videotape
or modified written English. Materials are also needed that
focus on assisting students in developing assertiveness and
social competencies, improving self-esteem and strategies
for resisting negative peer pressure. Schools need to be proactive
and ensure that counselors are able to identify potential
chemical abuse problems. Each school should have some kind
of prevention program in place and clear consequences if students
violate the drug/alcohol policy. Some
schools have set up peer advisor programs or sober social
clubs which has helped to support students who are at risk.
Schools should establish a drug/alcohol committee made
up of parents, students, staff and community members to review
existing policies and ensure that prevention services are
provided to students. Policies should
include clear consequences that are consistent. Some schools
use community service as well as the suspension from athletics,
student boards or other school activiites as consequences
related to drug/ alcohol use. Training should be provided
to instructional, clinical and residential staff regarding
drug/alcohol issues and the related policies and procedures
of the school.
An Overview of a Model Program
The Minnesota Chemical Dependency
Program for Deaf and Hard of Hearing Individuals (MCDPDHHI)
currently provides assessment, treatment and aftercare services
to Deaf and hard of hearing persons. As a national model the
program offers a staff of professionals trained and experienced
in substance abuse and deafness. Unique materials and approaches
developed and utilized by the Program help to provide individuals
with the opportunity for a quality treatment experience.
The (MCDPDHHI) was established
in 1989 to meet the chemical dependency treatment needs of
Deaf and hard of hearing individuals in an environment that
was able to meet the communication and cultural needs of this
population. Initially designed with an adolescent focus, the
Program expanded to serve persons aged sixteen years and above.
In 1990, the Program was the recipient of a grant from the
Center for Substance Abuse Treatment to serve as a model program
for substance abuse treatment of Deaf and hard of hearing
persons. The grant, initially funded for 3 years and later
renewed for an additional 2 years, provided the development
of an assessment tool, the programs clinical approaches,
specialized treatment materials, outreach and training services
and dissemination of materials and information. In addition,
the Program also received two grants from the Office of Special
Education and Rehabilitation Services. One grant provided
intensive four day professional Development Forums focused
on training professionals who work with Deaf and hard of hearing
clients who may be chemically dependent. The other grant provides
a certificate in Chemical Dependency and Deafness through
the University of Minnesota.
References
American Psychiatric Association. (1994).
Diagnostic and Statistical Manual of Mental Disorders
(fourth edition.). Washington, DC: Author.
Center for Substance Abuse Treatment. (1995).
Treatment Improvement Protocol: The Role and Current Status
of Patient Placement Criteria in the Treatment of Substance
Use Disorders. Rockville, MD.: USDHHS.
Evans, K. and Sullivan, J., (1990). Dual
Diagnosis: Counseling the Mentally Ill Substance Abuser.
The Guilford Press, New York.
Grant, B.F. (1992). DSM-IIIR and proposed DSM-IV
alcohol abuse and dependence, United States 1988: A nosological
comparison. Alcoholism: Clinical and Experimental Research
16(6): 1068-1077.
National Household Survey on Drug Abuse.,
(1992). National Institute on Drug Abuse, United States Department
of Health and Human Services, Rockville, MD.
Schaefer, D., (1996). Choices & Consequences:
What to do when a teenager uses alcohol/drugs. Johnson
Institute, Minneapolis, Minnesota.
Vailant, G., (1983). The Natural History
of Alcoholism: Causes, Patterns, and Paths to Recovery Cambridge,
MA: Harvard University Press.
Appendix A
Substance Abuse Assessment
Minnesota Chemical Dependency
Program for
Deaf and Hard of Hearing
Individuals
Client Name: ___________________________
Date: _______________________________
Assessor: ____________________________________________________
Referred by: ____________________
Agency: ________________ Phone: _______________
Reason for Referral:
_________________________________________________________________
Background Information
Date of Birth: ____________
Age: ___________ Gender: M / F
Marital Status:
______________ Living Arrangement:; _______________________________
School Status: ______________
Employment Status: ________________________________
Communication Preference:
__________________________________________________________
Family Incidence
of Hearing Loss? YES / NO If yes, identify members: _________________________
Family Incidence
of alcohol/drug problems? YES / NO If yes, identify members:
________________
_________________________________________________________________________________
Other background
information: _________________________________________________________
__________________________________________________________________________________
Treatment History
Admissions for Detox:
Place ______________________________
Dates __________________
Place ______________________________
Dates___________________
Admissions for Treatment:
Place __________________________
Inpatient / Outpatient Dates ___________________
Place __________________________
Inpatient / Outpatient Dates ___________________
Longest period of sobriety after
treatment: ____________
Most recent period of sobriety:
______________
Problems Related to Chemical Use
Physical Problems
_____ Hangovers _____ Tolerance
_____ Withdrawal
_____ Blackouts _____ Accidents/Injuries
_____ Passing out
_____ Fights _____ Injecting
drugs _____ Medicating pain
Comments:
Financial Problems
_____ Unpaid Bills _____ Borrowing
money _____ Outstanding loans
_____ Legal fines _____ Stealing
_____ Dealing
_____ Lifestyle change _____
Insufficient income _____ Pawning items
Comments:
Family Problems
_____ Arguments/fights _____
Abuse _____ Broken promises
_____ Absence from home _____
Loss of trust _____ Concerns about use
_____ Use by other members _____
Hiding drugs in home _____ Custody issues
Comments:
Legal Problems
_____ Arrests _____ Near arrests
_____ DWI/DUI
_____ Gang Involvement _____
Court Appearances _____ Parole
_____ Restraining order _____
Domestic violence _____ Probation
Comments:
Job / School Problems
_____ Poor performance _____
Lateness _____ Absences
_____ Problems with supervisor
_____ Fired/Suspended _____ Disciplined
_____ Problems with peers _____
Using at work/school
Comments:
Social Problems
_____ Loss of friends _____ Change
of friends _____ Friends use
_____ Socialization around use
_____ Negative reputation _____ Gambling _____ Friends older
/ younger
Comments:
Emotional Problems
_____ Use to feel normal _____
Mood swings _____ Self harm
_____ Suicidal thoughts/behavior
_____ Anger problems ____ Depression _____ Use to medicate
emotional pain
Comments:
Chemical Use Information
_____ Unplanned use _____ Binge
Use _____ Hidden use
_____ Using more than planned
_____ Solo Use _____ Daily use
_____ Attempts to control use
_____ Relapse _____ Preoccupation
_____ Protecting Supply _____
Poly drug use
Comments:
Identify chemicals used.
For each chemical, identity age of first use & present
pattern of use.
_____ Alcohol _____ Marijuana
_____ Cocaine
_____ Crack _____ Inhalants _____
Sedatives
_____ Hallucinogens _____ Amphetamines
_____ Opiates
_____ Others: ______ Others:
______ Others:
Use information: ____________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Diagnostic Features: Please check all
that apply.
_____ TOLERANCE need for increase
amounts of substance to achieve intoxication or markedly diminished
effect with continued use of the same amount.
_____ WITHDRAWAL characteristic
syndrome or same or closely related substance taken to relieve
or avoid withdrawal symptoms.
_____ SUBSTANCE taken in larger
amounts or over longer period than intended.
_____ PERSISTENT desire or unsuccessful
efforts to cut down or control use.
_____ TIME spent in activities
necessary to obtain substance or recover from its use.
_____ SOCIAL, OCCUPATIONAL ,
RECREATIONAL activities given up or reduced because of use.
_____ CONTINUED use despite knowledge
of physical or psychological problems caused or exacerbated
by the use.
Interview Findings and Comments:
|