ATP - Assessment &
Of Contents - ATP Process
Focus Of ATP
Step 1: Screening, Intake, and Stabilization
Step 2: Presenting Problem
Step 3: Life and Addiction
Step 4: Recovery and Relapse
Step 5: Assessment Profile
Step 6: Final Problem List
Step 7: Diagnostic Presentation
Step 8: Initial Treatment
Step 9: Comprehensive
References & Bibliography <Go
To ATP Bibliography>
Focus Of ATP
Recognizing addiction and coexisting mental and
personality disorders, stabilizing the client, & implementing an appropriate treatment
This component presents general guidelines for:
Completing a screening evaluation and comprehensive
assessment for addiction and coexisting personality and
Developing a brief strategic treatment plan based upon
the outcomes of the assessment. Master treatment plans
are included that can be customized to meet the individualized needs of clients
Clients undergo a comprehensive screening interview to
determine their appropriateness for treatment and
then complete stabilization to assure that they are abstinent from alcohol and
drugs, free of acute withdrawal symptoms, and mentally, emotionally, and
behaviorally stable enough to complete the treatment process.
The goal of ATP is to complete a comprehensive biopsychosocial
screening and assessment that results in:
Symptom Profile: ATP
is designed to create an organized Biopsychosocial profile of symptoms that are
related to substance use disorders, mental disorders, personality disorders, and
situational life problems. Each
symptom will include a standardized rating of symptom severity.
Problem List: ATP
results in a prioritized problem list that links each identified problem to the
presenting problems, its onset and development in the life addiction and mental
health history, and the disorder(s) that the problem is related to.
Target Problem: ATP
identifies the target treatment problem which is the most important problem that
needs to be the primary or central focus of the initial treatment plan.
Initial Treatment Plan: ATP
develops an initial treatment plan consisting of a personalized problem title, a
personalized problem description, an outcome goal, and an action plan (a series
of linked clinical interventions designed to accomplish the goal)
This is a brief evaluation that has the goal of placing the
the proper type of
treatment (based upon current level of motivation, knowledge of
foundational recovery skills, and immediate relapse risk).
The type of treatment is determined by nature and severity of the primary
target problem on the treatment plan, the goals, and the activities of the
the proper level of care (based
upon the client’s level of physical, psychological, behavioral, and social
stability). The level of care
determined by the client’s current level of stability and an assessment of the
amount of environmental support and supervision he or she receives while
completing the activities on the treatment plan.
When clients are able to rationally think and talk about the
problems that caused them to seek treatment, the presenting problems are
reviewed an analyzed. This analysis
of the presenting problems involves the following steps:
Developing the initial list of presenting problems and writing a that
list using bullet statements
Analyzing the client's level of biopsychosocial stabilization.
(If the client is unstable due to intoxication, withdrawal, or post acute
withdrawal (substance induced organic mental disorders) they are referred for
detoxification and stabilization before an indepth assessment is completed)
Clarifying each problem by writing a title
and a description sentence describing the problem in more detail;
Rating the severity of subjective pain and objective dysfunction that
each problem causes for the client using a 10 point rating scale (0 = no pain or
dysfunction; 10 = Sever pain and dysfunction).
Clarifying the relationship between each presenting problem and the use
of alcohol and drugs.
Clarifying the relationship between each presenting problem and any known
mental health problems (i.e. mental or personality disorders)
Projecting the logical consequences of each problem if the client
continues to use alcohol and drugs;
Grouping the problems into related clusters to see how the symptoms are
related to one another and to determine if there is one or more core or central
issues that are causing secondary problems.
Prioritizing the problems in order of importance (Is this a core or
central problem that will result in the spontaneous resolution of other problems
when resolved?) and severity (how seriously is this problem interfering with the
client’s current ability to function.
The life and addiction has three primary goals:
to identify and clarify the sequence of life events that have brought
them to their current position in life; and
to identify the pattern of alcohol and drug use during each major phase
of their life history; and
to identify what the client believed that alcohol and drugs could do for
them that they could not do for themselves without it.
The recovery and relapse history is designed to identify and
clarify each episode of recovery and each episode of relapse.
The primary goal of the recovery and relapse history is to organize a
time line of critical events in the recovery process and to analyze the key
decision points that caused clients to initiate a new period of recovery or
decompensate into a new period of either substance use or disabling symptoms of
a mental health disorder. This is done by completing two processes:
Analyzing the decision points that started each episode of recovery and
analyzing the decision points that led to each episode of relapse.
The decision points of recovery are analyzed by
identifying the problems that prompted the person to start each episode of
recovery, clarifying what they wanted recovery to do for them, and exploring
what happened in each episode of recovery that set them up to go back to
relapse. The decision points of
recovery are analyzed by using two key focusing questions:
What did you what recovery to do for you that you couldn’t do for
yourself while using alcohol and drugs? Did
recovery give you what you wanted?
The decision points of relapse are analyzed by
identifying the problems experienced during recovery that prompted the person to
start using alcohol or drugs, clarifying what they wanted alcohol or drug use to
do for them, and exploring what happened in during relapse episode that made
them want to get back into recovery. The
recovery and relapse history is also designed to analyze each relapse episode to
determine what they wanted alcohol and drugs to do for them that recovery
wasn’t doing and whether or not the relapse gave them what they wanted.
The decision points of relapse are analyzed by using two key focusing
questions: What did you what alcohol or other drugs to do for you that
you couldn’t do for yourself while abstinent? Did you get what you wanted from using alcohol or other drugs?
The assessment profile is organized summary of the significant
results of the assessment. This
normally consists of the following:
Profile of Disorders: The profile of disorders is a listing of all of the
coexisting disorders that were identified during the assessment. The disorders are organized as Substance Use Disorders
(specified by drugs of choice), Mental Disordered, Personality Disorders, and
severe situational problems requiring counseling (DSM V-codes).
It is important the profile of disorders have a brief no-nonsense
explanation of each disorder and a simple plain-English title for the disorder.
Symptom Profile: The symptom profile is a comprehensive list of the specific
symptoms of substance use disorders and coexisting mental and personality
disorders. A symptom is described
as an area of dysfunction related to the identified disorders.
The symptom profile is developed by working with clients to complete
symptom checklists for substance use disorders and the common coexisting mental
disorders, personality disorders, and lifestyle problems.
A biopsychosocial assessment grid is used to identify the relationship
between biological, psychological, and social symptom clusters.
When the symptoms of all disorders are identified
and organized together, two types of symptoms can be identified:
(1) Holistic Symptoms:
The common symptoms that relate across all identified disorders; and (2) Disorder-specific
Symptoms: Symptoms that are
associated with only one disorder and are not shared by the other disorders.
Personality Profile: The personality profile describes the essential
characteristics of the clients habitual way of relating to self, others, and the
Life Style Profile:
The lifestyle profile describes the common habitual structures of the
client’s normal way of living and identified the lifestyle components that are
centered around and support addiction and coexisting disorders and those that
support sobriety, responsibility, and normal functioning.
An assessment the global
personality and life style patterns that
contribute to relapse is identified by completing a comprehensive self
assessment of the life, addiction, and relapse history;
The final problem list is developed by clarifying the important
problems which the client must address in order to develop a stable and
meaningful lifestyle of sobriety and responsibility. In a well written final problem list each problem has a title
(a word or phrase that summarizes the meaning of the problem) and a description
( a single sentence that describes the dynamics of the problem).
A well written problem list is prioritized in three ways:
by problem severity (how much does it interfere with
normal acts of daily living?)
by problem significance (is it a central or core
problem that will result in the spontaneous remission of other secondary
problems if resolved?), and
by developmental problem solving (In what order do
the problems need to be addressed?)
The first problem on the problem list needs to be the Target
Treatment Problem. The
target treatment problem is the central or core problem that is selected to be
the primary focus of the current treatment plan.
One of the primary goals of the Final Problem list is to organizer the
problems is such a way so that it is clear that the first problem on the
prioritized problem list (i.e. the target treatment problem) needs to be the
first problem that becomes the central focus in treatment.
The goal of the diagnostic presentation is to give both the
client and family members with an overwhelming and undeniable argument that
the client is suffering from the diagnosed disorders, that recovery is
possible, and that a comprehensive treatment plan needs to bring implemented
that addresses the chronic and persistent symptoms of these disorders.
The diagnostic presentation describes in no-nonsense language exactly
what is wrong, what the painful problems are the client and significant others
are experiencing, and then explains that recovery is possible and that these
problems can be either resolved or effectively managed in ways that
significantly reduces pain and dysfunction.
The process of preparing for a diagnostic presentation
involves: (1) organizing the
identified disorders and symptoms in a way that shows that logical connections
to the clients Motivational Crisis and shows how all problems and symptoms
relate to one another to create the motivational crisis;
(2) Listing the prioritized problems in column one of a four column form
with the other three columns being left blank to list the relationship of each
problem to alcohol and other drug use (in column #2), to identified mental
health disorders (in column #3), and projecting the logical consequences of
refusing to address that problem in treatment (in column #4).
The client is then asked to review the contents of all four columns and
is asked to make a decision about what they want to do.
A black and white choice is given: either
(1) enter a treatment process to solve the problems, or (2) refuse treatment and
continue struggling to cope with the problems without help and risk the logical
consequences of the problems getting worse.
The diagnostic presentation sets the stage for the development
of the Initial Treatment Plan which involves development an
abstinence contract, a schedule of treatment activities, and an initial
structured recovery program that will support the client during initial
treatment. The initial treatment is
designed to resolve the Motivational Crisis, provide Biopsychosocial
Stabilization, get the client involved in a setting and systematic
process in which they can develop a comprehensive treatment plan.
This normally involves:
ATP Step 8-1: The
Abstinence Contract: The
abstinence contract is an agreement to abstain from alcohol and other mood
altering substances for the duration of treatment and to abstain from behaviors
that exacerbate the symptoms of coexisting mental or personality disorders.
The abstinence contract results from the process.
ATP Step 8-2: Schedule
of Treatment Activities: The
therapist recommends an initial schedule of treatment activities that includes a
level of care recommendation (inpatient vs. outpatient), an intensity
of care recommendation (how frequently sessions are scheduled), and the modality
of care recommendation (either individual therapy, group therapy, psycho
educational programs, supervised participation in self-help programs such as
Alcoholics Anonymous, or a combination of two or more).
ATP Step 8-3: Structured
Recovery Program: An initial
structured recovery program is developed by collaboratively identifying the
recovery activities and other acts of daily living that are required to support
initial abstinence, mental status stability, and lifestyle stability during the
period of active treatment. The
structured recovery program is an important tool for monitoring a client’s
motivation for treatment and identifying relapse warning signs.
A comprehensive treatment plan is then developed to manage the
most disabling symptoms. This is
done by matching to the clients current needs in recovery to realistic goals and
easy to follow action steps. This
is done as a collaborative process by securing a voluntary commitment to
complete the action steps of that treatment plan.
The treatment plan is a written document that identifies the
target problem (the problem that will be the central focus of the current
treatment efforts), the goal (the outcome that needs to be achieved to resolve
the target problem, and an action plan (the specific steps that will be taken to
resolve the problem and achieve the stated goal, an outcome evaluation that
measures the level of completion of step of the action plan and the over all
level of achievement of the stated goal.
A comprehensive treatment plan has the following components.
ATP Step 9-1: The Target
Problem: The target problem is
the central or core issue that will become the central focus of treatment.
The problem statement is written in a format that includes a title (a
word or short phrase that captures the key characteristic of the problem) and a
description (A sentence or short paragraph that describes the problem.
In working for the goal of recovery from a chronic lifestyle
related illness or disorder there are typically four standard problems that are
dealt with sequentially as a person moves through a developmental recovery
process. These are:
Standard Problem #1: Denial
and Resistance: The client
is exhibiting strong denial of substance abuse and strong resistance to
following a standard program of recovery in spite of clear evidence from the
assessment that they are suffering from a substance use disorder;
Standard Problem #2: Immediate
High Risk of Relapse: The
client is facing a number of high risk situations which present an immediate
risk of relapse and does not have the confidence or the necessary recovery
skills or coping strategies to either responsibly avoid and responsible deal
with the situation without relapsing;
Standard Problem # 3: Lack
of Foundational Recovery Skills: The
client recognizes and accepts that they are suffering from a substance use
disorder but lacks an accurate understanding of substance use disorders and the
process of recovery, and the available recovery tools and supportive services;
Standard Problem #4:
Personality and Lifestyle
Problems: The client
currently has a stable recovery but is exhibiting a number of core personality
and lifestyle problems that increase the risk of relapse by creating a state of
chronic low grade stress and problems that interferes with their recovery
program and with their ability to comfortably adapt to a lifestyle of sobriety.
ATP Step 9-2:
The Goal: A goal is a
measurable outcome goal and the projected date by which it will be completed.
The goal is a statement of the desired successful outcome of treatment.
The goal should be expressed in a concrete and specific manner that
allows the client to develop a concrete visual image of exactly what his or her
life will look like when this problem is resolved.
ATP Step 9-3:
The Action Plan: An
action plan is a tightly linked sequence of activities that describes the exact
steps that will be taken to achieve the stated goal.
Each step of the action plan is concrete and specific and is linked to s
specific treatment activity (individual group, or Pyschoeducation sessions) and
homework assignment designed to help the client to complete the activity.
An action plan describes a sequence of action steps that will
be used to achieve the stated goal. Each
step of the action plan identifies: (1)
a specific clinical process; (2) a preparation homework assignment; (3) the type of
clinical session (individual therapy, group therapy, Pyschoeducation) in which
the assignment will be processed; (4)
the date and time of the clinical session;
(5) the resources that will
be available to the client for preparation and completion of the action step,
and (6) an outcome evaluation
ATP Step 9-4:
The Outcome Evaluation: The
outcome evaluation is a quality assurance tool that measures the level of goal
attainment for each individual step of the action plan and for the overall level
of goal attainment for the treatment plan using a ten point scale (0 = No goal
attainment; 5 = partial goal
attainment; 10 = full goal
ATP Step 9-5: Referral:
The final step in developing a comprehensive treatment plan with a client
is to completing a confirmed referral to the appropriate level and type of
treatment that can supervise the completion of the treatment plan.
In some programs, the clients will complete the treatment plan under the
supervision of the therapist who completed the assessment, in other programs the
client will be referred to another therapist within the agency or to another
agency to complete the treatment plan.
Treatment Plans: Model treatment
plans for each of the CENAPS® Core Components are presented in the
description of each.
ATP was developed as result of over 30 years of clinical experience
Terence T. Gorski and continuous updating based upon the emerging
clinical literature. To review the bibliography of sources used to
ATP click here <ATP Bibliography>