Interview with Kenneth Minkoff, MD
Athealth.com: Are there assessment tools that you would recommend for mental health specialists who are not chemical dependency specialists, and vice versa?
Dr. Minkoff: There is not a single assessment tool that solves all of your problems for you. The proper assessment tool depends on what you are assessing. One of the most important things for me is to obtain a comprehensive history.
Athealth.com: Can you please say more about this?
Dr. Minkoff: Certainly. The history has to be longitudinal. This means that it has to be organized in chronological order using a timeline approach. Within every significant time period in the timeline, the history needs to integrate mental health information, substance use information,
and level of functioning so that the clinician gets a picture of patterns of behavior over time. That really leads to a better sense of diagnosis than just isolated instances of intoxication or suicidality.
You look at patterns of mental health symptoms, treatment that has been provided, the response to treatment, substance use patterns, efforts to control or not control substance use, treatment and response, etc.
Also, you pay attention to interactions at this specific point in time between the two. And then you move along to the next time period. You particularly emphasize in this assessment process looking at periods when people did well, because you want to identify their strengths.
You want to assess each disorder when you have information that the other disorder was stable. You can do that very nicely by getting a good history, which is ultimately reasonably predictive of what you will need to do in terms of going forward.
Athealth.com: And other tools that you might recommend?
Dr. Minkoff: There are a number of screening tools that can be used in mental health settings to do a rough screening for the possible presence of substance use disorder. These include the CAGE, DALI (Dartmouth Assessment of Lifestyle Inventory), MAST (Michigan Alcohol Screening Test), and the SMAST (Short Michigan Alcohol Screening Test). I have a modified version of the SMAST, called the MIDAS (Mental Illness Drug and Alcohol Screening--not yet validated and tested) that incorporates questions geared a bit more to people with serious mental illness.
As for separate tools for looking at mental health symptoms in substance settings, there is one called the Mental Health Screening Form that was developed by Project Return in New York City, which is quite nice. Some people use something like the Brief Psychiatric Rating Scale (Overall & Gorham); or the Brief Symptom Inventory (Derogatis). Some people like the MINI, and there are others as well.
Additionally, there are tools for assessing stage of change:
- Readiness to Change Questionnaire based on the work of James Prochaska and Carlo DiClementi;
- the Stages of Treatment Scale that was developed by Robert Drake's group;
- SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) which was developed by William Miller; and
- the URICA, developed by Carlo DiClementi, which is for assessing stage of change.
Athealth.com: What about the tool you developed and work with, MAGIC?
Dr. Minkoff: The MAGIC (Motivational Assessment Guide for Intervention with Clients) is not a scale. It is an interview guide that I use for helping clinicians assess motivation regarding substance use for people with serious mental illness.
Athealth.com: Dr. Minkoff, thank you very much for you time today; and thank you for sharing your insight, experience, and expertise with us. It was a pleasure talking with you.
Page last modified or reviewed on March 8, 2009
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