Denial

Though they may acknowledge they are addicts, users, or abusers, they fail to recognize and acknowledge the magnitude and impact their addiction has upon themselves and/or others.

Obsessions

The presence of unremitting intrusive thoughts associated with a particular act, or substance, directly interfering with Focusing, Attention, and Concentration.

Ritualism

The performance of the act, or use of the substance is ritualistic. e.g. The minute pieces of behaviors leading to the use or action are underscored with specific sequences.

Persistence

The act or use persists in spite of known and previously experienced averse, or negative consequences to themselves, or others around them.

Abstinence

A profound inability to abstain from the act, or use, for a period of 30 days, regardless of occasion.

Degree of Impairment - Please Score All items within All 3 sections with a score ranging from 1 to 3. :

• 1 = Totally unremarkable - perfectly normal, absent - No issue.
• 2 = Questionable, may be Problematic.
• 3 = Remarkable, or serious, or pervasive, or a definite "Yes".

1. Family History

A family history of addiction, and/or severe chronic psychopathology, inclusive of serious personality disorders.

Here we look for marital constellations comprised of Ocpd with Passive-Aggressive partners. or

Bpd with Oc, or Disthymic pd. or

Enmeshed family systems evincing high levels of dramatic, or histrionic Pd.

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2. History Developmental

Early development is underscored within a chaotic family environment that may have included either serious parental conflict, or contested, and/or adversarial divorce, or verified negligence, or verified abuse, or overindulgence, or serious mood lability in one or both parents, or any combination.

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3. History Parental

An early developmental environment where, at least one of the parents, caretakers, or 1st-degree blood relative engaged in threats, verbiage, or gestures, or attempts at, suicide.

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4. History Patient

The presence of either intermittent academic underachievement, or progressively increasing levels of underperformance, or behavioral difficulties.

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5. Clinical Patient

The presence of symptoms and signs (early or mid childhood) of ADD/ADHD, Autistic Spectrum, Oppositional Defiant, … and/or temperamental, or characterological deficits Early (Before age 14) experimentation with ‘pot’ ‘alcohol’ ‘tobacco’.

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6. Legal Patient, or Family

Applies to patient, and/or a cohabiting family member -- Judicial, or Law-enforcement, or Police involvement prior to age 18 ;regardless of reason. Includes calls to Police, 911, arrest even if not detained, or prosecuted.

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7. Developmental Signs

Bed wetting after age 4, or Fire-setting, or fascination with fire, cruelty to animals, persistent lying or deceitfulness. ..

Please score if any of the above, however minor, isolated, ... and regardless of reason

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8. Early Use Patient

Use of stimulants, and/or amphetamines (Adderall or Dexedrine) and methylphenidate (for example, Concerta, Metadate CD, or Ritalin), Atomoxetine (Strattera)…and others) before Age 14, even if prescribed by an MD for ADD/ADHD .

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Unless in a state of urgency, and/or desperation, the patient may simply be seeing a professional for an annual physical, or upon the insistence of parents about issues unrelated to addiction, or in some cases as a court mandate.

9. Presentation Amiability

(S)he may present as a normally developing individual, appearing healthy, amiable, happy, and humorous.

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10. Presentation Guarded

(S)he may present as a normally developing individual, who is shy, reserved, guarded, and may be avoidant, tenuous or tentative in his or her answers.

(S)he may frequently use "I don't know", "perhaps", "probably", "maybe", "sometimes", "not always", "it depends". Eye-contact maybe intermittent.

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11. Patient-Facial-Animation

Affect (The facial intonation and facial-emotional-expressiveness), maybe be -ever so subtly - blunted, constricted, or lacking in animation, or range; Often one of the indications of cannabis use, or more serious psychopathology.

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12. Presenttn Psych Vitals

Impairments, or peculiarities in Psych vitals such as Affect, Associations, Ambivalence, Abstraction, Affiliation, and Autism.

Affect Referring to the emotional intonation, and/or modulation of the facial expression that may be impaired, or of limited range as in being flat, constricted, blunted, inappropriate, or incongruent to thought and mood.

Associations referring to a process or ability to maintain a cohesive and coherent train of thought void of loss of associations from one thought to another resulting in going off in tangents, being circumstantial, or engaging in word-salads, or introducing neologisms.

Ambivalence An ever-present state of conflicting ideas, attitudes, and emotions towards one's self and/or others that impede motivation, action, and decisiveness often leading to depersonalization, and depilating dysphoria and anxiety.

Abstraction Referring to the ability to think, decipher, and interpret proverbs, and/or spoken words, void of concrete, semantic, or literal interpretations. Able to understand proverbial ideas, humor, or theoretical constructs, and generally think in abstract and/or in conceptual fashion.

Affiliation Referring to the innate capacity, as well as desire, and needed relatedness , for in-depth social interactions that go beyond a circle of 'relatives'.

Autism implies a tendency to self-isolate along with some peculiarities in thinking, and/or ideas.

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13. Presentation Complaints

More often than not, there will be some complaints (however minimized, or rationalized by the patient) of sleep issues, weird dreams, and on further probing a propensity towards protracting and procrastination with a history of difficulties in completing objectives, goals, or tasks..

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14. Developmental Collaterals

Collateral information from the parents, siblings, or caretakers might reveal serious discrepancies with patient accounts, and/or serious intra-parental accounts surrounding the present status, as well as the historical-developmental status and events.

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It is imperative that a complete medical/physiological and clinical-lab inclusive of Tox-SAP 10, GC/MS; -not simply Urine- be performed, and a complete exam of the naked body reveals no injection sites in the arms, phalanges, stomach, ... and no remarkable findings for any abscesses or inflammations, be it oral, or otherwise.

Tox SAP 10, GC/MS

Typically testing for substances, including Barbiturates, Benzos, Methadone, Methaqualone, Propoxyphene, THC, Opiates, PCP, Cocaine, and Amphetamines.

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SMA 24

Typically testing for Glucose, Cholesterol, Triglycerides, Iron, Protein Total, Globulin, A/G Ratio, LDH , Aspartate Aminotransferase-AST, Alanine Aminotransferase-ALT , Albumin, Bilirubin total, GGT, Alkaline Phosphatase, Calcium, Phosphorous, Uric acid, Blood urea nitrogen, Creatinine, Sodium, Potassium, Chloride, Carbon Dioxide, Estimated GFR-African American, Estimated GFR-non African American.

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T3 - T4 Thyroid

Typically testing for Thyroid-stimulating hormone (TSH) Free thyroxine (free T4) Total or free triiodothyronine (total or free T3)

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Kidney Functions

Blood and urine tests show how well the kidneys are doing their job and how quickly body wastes are being removed.

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The Medical Evaluation is essential prior to any attempt for validation, and/or treatment !

• If any 4 items in the History and Developmental have scores that are equal to, or above above 2, the probability of addiction, or 'risk-of-addiction' will be in need of a more comprehensive evaluation.
• If items 7 and 8 in the History and Developmental, as well as #9 and #11 and #12 in Presentation, have scores that are equal to, or above above 2, not only is the probability of addiction high, but very serious psycho-pathology may be considered.
• If items 10 and 13, and 14 under "Presentation" have scores that are equal or above above 2, the probability of addiction, or 'risk-of-addiction' will be in need of a more comprehensive evaluation.
• If any 4 items in the History and Developmental have scores that are equal to, or above above 2, and item 14 has a score that is equal or above above 2, for discrepancies, it may imply that whatever other serious issues of addiction may be present, there is a very high probability of intra-family discord and either enabling, or facilitating addictive, or sociopathic behaviors.