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

44 II. ASSESSMENT OF ADDICTIONfor psychopathological symptoms to dissipate in conjunction with abstinencefrom alcohol and drugs following the initial period of detoxification and withdrawal.Furthermore, it is essential to recognize that emotional distress can bothprecipitate and sustain a psychopathological disorder. Characterizing the client’semotional status therefore enables the clinician to determine the relationof psychopathology to substance abuse either as a predisposing condition, a correlateof the disorder, or a consequence of the disorder.In contrast to diagnostic psychiatric assessment, psychological tests measuretraits. The evaluation is thus concerned with quantifying the person onparticular dimensions, whereas the psychiatric evaluation categorizes the personaccording to presence or absence of a disorder. Hence, commonly used psychiatricinterviews such as the Schedule for Affective Disorders and Schizophrenia,Diagnostic Interview Schedule, and Structured Clinical Interview forDSM-III-R are concerned primarily with dichotomous classification. Whethera categorical or dimensional approach is utilized, the most frequently observedpsychopathological disturbances comorbid to alcohol or drug abuse are anxietyand depression. However, virtually every Axis I and Axis II disturbance hasbeen observed concomitant to substance use disorder (Dackis, Gold, Pottash, &Sweeney, 1985; Daley, Moss, & Campbell, 1987; Helzer & Pryzbeck, 1988;Peace & Mellsop, 1987; Weissman, 1988).BehaviorThe third component of a comprehensive psychological assessment pertains todetermining the degree to which the individual’s behavioral characteristics arerelated to substance abuse. Behavioral adjustment can be characterized in bothmicroenvironment (e.g., family and friends) and macroenvironment (e.g.,work, community, and school). Importantly, behavioral disposition, such asantisocial personality disorder, mitigates optimal functioning in a variety ofsocial contexts. The point to be emphasized is that behavioral adjustment is theproduct of the interaction between the individual and the particular context. Abehavioral characteristic (e.g., aggressiveness) can be adaptive in one contextand maladaptive in another context.Many behavioral characteristics have been shown to augment the risk forsubstance abuse, as well as to covary with substance abuse severity. The mostcommonly reported features include impulsivity, aggressivity, thrill seeking,poor goal persistence, hyperactivity, and social nonconformity (Spear, 2000;Tarter et al., 1999).Cognition, emotion, and behavior comprise the major domains of psychologicalfunctioning. Notably, the facets of these three processes pertaining toself-regulation are indicators of a unidimensional trait termed neurobehavioraldisinhibition (Tarter et al., 2003). The score on this trait is highly predictive of