Phase 1: Assessment
In time-constrained counseling settings, efficient assessments are critical, and the C.A.R.E. model emphasizes this need. Thoughtful word choice is paramount during the Cannabis Assessment, fostering a strong relationship with the student from the outset. This carefully considered language allows for a more sensitive examination of their experiences, potentially revealing important information about cannabis use. By prioritizing mindful communication within the assessment, we maximize the opportunity to build rapport and gain crucial insights within limited appointment times.
Approximate Sessions: 1-2
Phase 1: Essentials
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How to Prepare
In Phase 1, you should have familiarity with the assessment your organization uses. Review the language used in the assessment and see what you may need to change. Depending on your organization this can vary from how you ask the question to re-writing part of the assessment.
Additionally, having paper on hand to make a genogram and a cheat sheet on common symbols and relationships can help speed the process along.
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Goals of the Phase
The goal of this Phase is to get a thorough picture of the client. It helps you understand what their presenting problem is, as well as assesses substance use accurately. While this model is designed with cannabis use in mind, it can be used for any substance, as unidentified problematic substance use can interfere with clients reaching treatment goals.
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Key Skills
Various interpersonal skills are useful during assessment. Keeping the goal of this phase in mind, the ability to use gentle assumptions when discussing substance use can help uncover the extent of cannabis use. Additionally, obtaining a genogram when discussing family history and inquiring about substance use in the family can provide a clearer picture of the student's home life.
Hear about Phase 1: Assessment
Key Takeaways
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Phase 1 of the framework focuses on assessment of the client.
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Include specific questions about cannabis use in your assessments, even if standard evaluations don't.
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Make gentle assumptions when discussing cannabis and avoid referring to it as a "drug."
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Directly asking about cannabis use is important to understand its potential role in the client's presenting problems.
Assessing for Cannabis
When assessing for problematic cannabis use, there are a few things to keep an eye out for, such as cravings, mood concerns, sleep issues, and impaired cognitive or psychosocial functioning or withdrawal (Loflin et al., 2020).
Below are tips on improving your assessments
01
Ask About Substance Use
While this may seem obvious, not all clinicians have asked about substances. Sometimes, agency forms do not have questions around them. Other times, clinicians are unsure what to do with the answers. The easiest thing to implement is to ask about a student's substance use. Discuss their substance use history. Find out about a family history of substance use.
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Don't Call It A Drug
Some students will say no when asked if they use any drugs while using cannabis. Students who have not reported use, not due to trying to hide it from their clinician but simply because they didn’t view it as a drug and were being in their view honest. Also, consider that some students can be using medical cannabis, which they may also not consider a drug.
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Use Gentle Assumptions
When asking a student about cannabis use, use gentle assumptions when phrasing the questions. Instead of asking if they use cannabis, ask how often they use cannabis. A student who uses very infrequently may not identify as a user, whereas if they only use a few times a year, they are more likely to say so in the later phrasing
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Cannabis or Marijuana
Due to US politics and policy discrimination, there is a deliberate choice in referring to it as cannabis over marijuana due to the tie to prejudice against Central Americans. Consider what you refer to and know why if a student asks.
Inheriting a client?
Clinicians may encounter situations where they begin working with a client without having personally conducted the initial assessment. This can occur due to variations in intake assessment procedures across different centers or when a client transitions care from another clinician. For these initial sessions, the following tips are provided to help increase effective engagement.
Be Direct
Be direct in saying: While I've reviewed your initial assessment, it's important for me to hear directly from you. Let's clarify a few points to ensure I understand things from your perspective, not just what was documented.
Use Gentle Assumptions
When reviewing their substance history, ask them, "How often do you use cannabis?" This type of question gives the client an opportunity to deny it if they do not or invite them to share more if they do use cannabis.
Go Into Detail
A client mentioning cannabis is an invitation to learn more. Open the conversation by asking 'What was it like when you first started using?' and 'How has your pattern changed?' These questions encourage a client-led exploration of their cannabis journey.
Case Vignette:
Tony
Tony was referred to the counseling center by health services after they found no physical cause for his reported erectile dysfunction (ED) issues. During the assessment, Tony disclosed daily cannabis use, sometimes multiple times a day, especially on weekends. While ED was his primary concern, Tony also presented with some general anxiety, specifically related to sexual performance. When I asked Tony about his cannabis use, he stated he was not concerned and had no desire to change it, viewing it as "natural, legal, and safe."
Alexa Young, CA