Module 2: Screening and Assessment

7B. Clarification of the Diagnosis

Sometimes a youth’s psychological symptoms can be attributed to intoxication, drug use, or withdrawal from drug use. For instance:

• Psychotic symptoms can be associated with intoxication from almost every class of substances
• Anxiety and depressive symptoms can be associated with intoxication or withdrawal from alcohol, cocaine, and sedatives
• High dose and chronic use of stimulants (e.g., methamphetamine) can provoke an episode of psychosis or mania. Stimulant withdrawal can produce symptoms of lethargy, depression, agitation, and insomnia for months after cessation of use (Ries, 1994)
• Subacute withdrawal syndromes may produce symptoms of hyperactivity, hyperarousal, and panic attacks. These symptoms may emerge weeks to months after the youth discontinues use of alcohol, stimulants, benzodiazepines, or opioids (Ries, 1994)

It is difficult, and sometimes impossible, in most cases to assess adequately the causes of symptoms if the youth continues to abuse substances regularly. A substance-free period of ime will help clinicians to clarify what behaviors, symptoms, or disorders are driving others.

Substance-Induced Disorders

Although some youth have both a substance abuse disorder and a psychiatric disorder, treatment providers must consider whether the youth’s presenting symptoms might be entirely substance-induced. The DSM-IV has been revised to include substance-induced disorders, meaning that the symptoms are thought to be the "direct physiological consequence of a drug of abuse, a medication, or a toxin exposure" (APA, 1994; p. 394).

Substance-Free Period

A substance-free period allows clarification as to what behaviors, symptoms, or disorders are driving others. Due to the lengthy withdrawal syndrome associated with many substances, a 4- to 6-week substance-free period is ideal to attribute symptoms reliably to causes other than the use of substances. However, deferring a mental health diagnosis can delay a youth from receiving appropriate treatment. Therefore, it is recommended that clinicians provide an interim psychiatric diagnosis, treat the symptoms, and reassess the youth in 7 to 10 days. These are not hard and fast numbers because of the many differences between substances, but a good general guide.