Functional Assessment and Functional Analysis

Assessment is a longitudinal process. New data that come to light as patients go through therapy have implications for adjusting and updating the specific diagnoses, and for solidifying or revising the treatment plan. Early assessment often involves open-ended questioning about the patient's functioning in everyday life, specially noting areas of impairment. A comprehensive intake ideally involves the administration of the SCID (e.g., First et al., 1995), during which the patient's mood disorder and substance abuse or dependence may be identified. In addition to ascertaining the patient's formal diagnoses, the clinician also does a functional assessment and analysis of the role of alcohol and other drugs in the patient's life. The functional assessment examines the patient's adjustment across a number of important life domains, including schooling and/or employment, health and safety, interpersonal relationships, legal involvement, and further areas of psychiatric symptomatology. The functional analysis examines the factors pertinent to the development and maintenance of the patient's use of alcohol and other drugs. These factors include high-risk situations (e.g., feeling lonely, getting paid, going to a bar), faulty beliefs (e.g., "I only drink beer, so there's no way that I can have an alcohol problem"), and reinforcement contingencies (e.g., a patient feels less anxious in social situations when he/she drinks, but then experiences negative consequences when he/she arrives late and hung over at work). Treatment planning develops as an outgrowth of these and other data (Newman, 2004).

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