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

3. Psychological Evaluation 55Behavior Rating Scale (Pelham & Murphy, 1987), based on DSM-III-R criteria(American Psychiatric Association, 1987), quantifies severity of conduct, andattention-deficit/hyperactivity and oppositional defiant disturbance. Anotherbrief symptom rating scale that can be completed by the teacher is the IowaConners Teachers Rating Scale (Loney & Milich, 1982).One important aspect of school adjustment pertains to the extent to whichthe child participates in athletics and other extracurricular activities. Theseactivities indicate how well the person is socially integrated and accepted bypeers. In addition, it is essential to evaluate academic achievement and learningaptitude in the basic skill areas. For example, learning disability compoundedby low self-esteem may be a major factor propelling a youngster towarddrug use, as well as other non-normative behaviors. Standardized learning andachievement tests can readily document whether a learning deficit is present.Vocational AdjustmentStress in the workplace fosters substance use as a coping strategy. Inability tomeet work performance standards, conflicts with other employees or supervisors,an inconsistent work schedule, and low job satisfaction exemplify thecommon proximal causes of substance use. The impact of unemployment andunderemployment as a source of stress also needs to be evaluated. In addition,extensive travel and associated social obligations may frequently place the individualin situations where alcohol consumption is expected. Over the longterm, social drinking may lead to problems controlling intake.Besides evaluating the job demands and workplace environment, it isessential to evaluate the client’s behavioral disposition. For example, premorbidpersonality disorders contribute to job failure, which in turn predisposes theindividual to substance abuse. Furthermore, it is important to evaluate substanceabuse in the context of specific circumstances of the job. Access toaddictive substances places the person at heightened risk simply by virtue offacile availability. Not surprisingly, bartenders have a high rate of alcoholabuse. The vocational evaluation must therefore identify the specific jobrelatedcharacteristics that predispose the individual to substance abuse.Recreation/Leisure ActivitiesSubstance use is commonly circumscribed to recreational activities. Furthermore,an individual who does not have socially satisfying leisure activities mayuse alcohol or drugs to cope with the stress of boredom. This may be particularlyproblematic among members of the elderly population who have notdeveloped a rewarding goal directed lifestyle following retirement. A somewhatsimilar problem may confront adolescents who have substantial unstructuredtime. Presently, there are no standardized procedures to evaluate recreation and