Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

3. Psychological Evaluation 43In summary, systematic delineation of cognitive strengths and weaknesses,particularly as they relate to the onset and pattern of substance use behavior, isimportant for several reasons. For example, an attentional disorder or learningdisability often precedes the onset of substance abuse (Tarter, Alterman, &Edwards, 1985). This has treatment implications, because it may be possible toprevent or treat the substance use behavior in some individuals by amelioratingthe problem that initially motivated drug use. In addition, the assessment ofcognitive deficits is important for understanding the person’s everyday abilities,such as remembering appointments, following directions, and learning newinformation and skills. Demonstrating the presence of a cognitive deficit alsoinforms about implementing a treatment plan that encompasses a cognitiverehabilitation component. For example, cognitive retraining by teaching theperson compensatory strategies when there is an irreversible deficit, or by reestablishinga capacity that was not permanently impaired, affords the opportunityto maximize social and vocational adjustment within the framework ofcomprehensive rehabilitation.EmotionThe intensity of emotional experience and appropriate expression of emotionare strongly associated with the quality of psychological adjustment. Conflictsover anger and guilt, and the display of intense emotional reactions commonlyaccompany substance use. These disruptive emotions may either presage substanceuse or emerge following drug use onset. Not uncommonly, consumptionof psychoactive substances is motivated by a need to ameliorate negative affectivestates such as anger, depression, and fear. The inability to express emotionseffectively in the social context, particularly negative feelings, is also frequentlyassociated with drug abuse.Emotional disturbance is often encompassed within psychopathology.From the psychometric perspective, clinically significant psychopathology ispresent when severity exceeds two standard deviations from the populationmean. In effect, the severity score ranks in excess of the 95th percentile in thepopulation on a trait (e.g., anxiety). Whether the magnitude of severity of psychopathologicaldisturbance points to the need for treatment can only be determinedby integrating the findings obtained from a diagnostic psychiatric interviewand psychometric assessments. For example, anxiety or depression mayfoster substance abuse in an individual even if the severity is subthreshold fordiagnosis. Notably, subthreshold negative affective states predispose to drugseeking (Khantzian, 1985). As pointed out by Dodes (1990), psychoactivedrugs modulate affect in part by ameliorating negative feelings concomitant tohelplessness and powerlessness.It is important to be cognizant of the possibility that a psychiatric disordermay remit following effective treatment of substance abuse. It is not uncommon