ABSTRACT
As already mentioned in chapter 2, it is imperative to conduct a thorough analysis of the different problem areas of the patient. This is critical in arriving at a clear definition of the problem behavior and in evaluating the effects of treatment. Several modalities of assessment can be distinguished. In addition to interviewing the patient, the most important methods are self-report using questionnaires, self-monitoring of behavior, and, in a number of cases, information provided by significant others (e.g., a partner). Questionnaires are often useful to generate a first impression of the problem behavior. In regard to substance-use disorders, the Time-line Follow-Back method gives a good impression of the quantity and frequency of drinking/drug taking during the past months, as well as more detailed information on pattern of substance use (Sobell & Sobell, 1992; Sobell, Toneatto, & Sobell, 1994). When additional problems are present in addition to the substance abuse (e.g., anxiety, depression, personality disorder, marital distress) the therapist can select from a number of questionnaires that collect domain specific information. When the domain is depression, the therapist can administer the Beck Depression Inventory, or BDI (Beck, Steer, & Brown, 1996), which was developed to assess the behavioral manifestations of depression, as well as, for example, the Pleasant events Schedule (macPhillamy & lewinsohn, 1982), which aims to assess to what extent the patient still initiates pleasant activities that may serve as reinforcers. The use of other questionnaires is illustrated in a number of case studies described in this chapter. In the case of interpersonal problems, role-playing can provide useful information that may supplement the information gathered through interviews, diaries, and questionnaires. An example may clarify this point:
Bill is a patient who regularly relapses into binge drinking after interpersonal conflicts. Although Bill reports feeling anxious in response to conflict and arguments, he claims not to avoid these situations and even to cope adequately. Bill's therapist suggests using role-play in order to clarify what actually happens during these situations. The therapist plays Bill's boss, who criticizes Bill for something that is not his, but a colleague's, fault. In trying to counter this criticism, Bill becomes visibly tense and immediately takes back his critical comments, which in return reduces his tension. Role-play of other situations (conflicts with his wife and his oldest son) revealed that Bill was incapable of dealing adequately with criticism. After such conflict situations he was inclined to start drinking heavily.
