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

3. Psychological Evaluation 51decision is made regarding the need for focused comprehensive testing. This isthe third and last stage of assessment. In-depth information is obtained regardinga particular cognitive domain. The results inform about “real-life” prospectsof success. Moreover, the results inform about potential risks to the person. Forexample, it is important to describe psychomotor impairments fully if the clientworks with power machinery. Visuoperceptual disturbances must be comprehensivelydocumented if the person drives a car. Similarly, if the clinician identifiesa learning or memory deficit, it has direct ramifications for educationaland vocational rehabilitation. The reader is referred to Nixon (1999) for a discussionof instrument selection for neuropsychological evaluation.In interpreting the results of a neuropsychological evaluation, it is importantto be cognizant of the multifactorial etiology of any identified impairment.Not only do alcohol and other drugs act directly on the brain but their habitualconsumption may also induce organ–system injury, which in turn disruptsintegrity of the brain. For example, cirrhosis, independent of alcoholism, causeshepatic encephalopathy, Thus, neuropsychological deficits commonly found inalcoholics may be, in large part, the result of advanced liver disease (Tarter,Van Thiel, & Moss, 1988). This fact is not inconsequential, because treatmentof low-grade hepatic encephalopathy caused by alcoholic liver disease hasbeen tentatively shown to improve cognitive capacities (McClain, Potter,Krombout, & Zieve, 1984). Thus, medically significant problems that potentiallydisrupt brain functioning should be recorded and incorporated into thetreatment plan.Family AdjustmentFamily organization and quality of interaction among its members impact onthe risk for and maintenance of substance abuse. Indeed, the transmission ofalcoholism across generations is to some degree influenced by attitudes and ritualsof the family pertaining to consumption (Steinglass, Bennett, Wolin, &Reiss, 1987). Inasmuch as the family is the primary influence shaping the valuesand behavioral patterns of children, parenting style and family environmentexercise a profound influence on the child’s development until at least adolescence,when psychoactive substance use may first become problematic.From the standpoint of psychological evaluation, a number of issues mustbe addressed. First, it is essential to characterize the contribution of psychiatricdisorder, including substance abuse, in the family. The greater the family densityof substance use disorder and pervasiveness of psychiatric disorder in familymembers of the client undergoing evaluation, the more severe the psychologicalproblems. Among young substance-abusing clients, it is especially importantto record the presence and history of physical and sexual abuse as an etiologicalfactor on any manifest psychological disturbances. Second, the causal relationshipbetween family dysfunction and drug use behavior needs to be ascertained.