This type of assessment is designed to help you examine the nature and extent of your alcohol or other drug use.  We will, together, evaluate your substance use and the possible impact of that use on a variety of areas (e.g., social, occupational, physical, intellectual, and emotional).  Throughout the assessment, we will offer feedback on the information you supply and will provide you with opportunities to ask questions important to you.

As a result of the assessment we will be able to examine the severity of your alcohol/drug use and the degree of risk for developing future problems related to your alcohol/drug use.  We will then be able to offer you recommendations for reducing any alcohol or drug use concerns that have been noted and for decreasing your risk of future health problems.

We perform a variety of assessments for purposes of immigration and naturalization.  Clients request testing for different reasons, some of which are:

• An individual is unable to pass the history and/or civics portion(s) of the citizenship test because of difficulties in acquiring the English language.  This could be due to low cognitive functioning, illiteracy in the native language, mental disability, or other psychological factors discovered through assessment.
• The individual's U.S.-born children or citizen parents or spouse would suffer extreme and unusal hardship if deported.
• The individual's U.S.-born children may be eligible for Special Education services that might be uncovered through assessment that would avail them to protection of federal US law.
• There may have been abuse and/or cruelty at the hands of the American spouse, which would need to be documented by a psychologist.
• The individual's U.S.-born children or citizen parents or spouse may depend on medical care that otherwise would not be available to or affordable for them.

Psychoeducational refers to the point at which thinking and behavior supports or interferes with educational achievement.  Testing and assessment carried out in our offices will facilitate the acquisition of learning and provide recommendations for compensatory strategies.  

Evaluations for verifying giftedness or uncovering learning disabilities.  Dr. Mirich is a certified bilingual School Psychologist.  He has experience identifying and assessing:

• IQ;
• Autism;
• Aspergers Syndrome;
• Social and emotional dysfunction;
• Gifted and talented individuals;
• Learning disabilities (reading, writing, math, etc.);
• Language disorders;
• Pinpointing processing disorders (short-term memory, long-term retreival, auditory or visual processing, speed of processing, etc.).

We use state-of-the-art tools and techniques to assess and evaluate a client's competency to proceed.  For example with adults, in addition to the standard clinical interview (or interviews, if needed) and psychological testing, we administer The MacArthur Competency Assessment Tool - Criminal Adjudication (MacCAT-CA) which is a structured and highly standardized 22-item interview for the pretrial assessment of adjudicative competence.  It was developed for use with adults 18 years of age and older whose competence to proceed in the criminal process is at issue, focusing on factors that may be involved in legal determination of defendants’ competence to proceed and their decisional competence.

The MacCAT-CA uses a vignette format and objectively scored questions to standardize the measurement of three competence-related abilities:  Understanding (capacity for factual understanding of the legal system and the adjudication process); Reasoning (ability to distinguish more relevant from less relevant factual information and ability to reason about the two legal options: pleading guilty or not guilty); and Appreciation (capacity to understand his or her own legal situation and circumstances).

It should be noted that neither the MacCAT-CA, nor any other criminal competence assessment instrument, assesses all of the factors relevant to a case.  In addition, different capacities may be more or less important in a particular case.  The MacCAT-CA is considered an integral part of a comprehensive evaluation of a defendant's competence that includes (a) consultation with the referral source, (b) gathering of relevant historical information, (c) assessment of current mental status, and (d) discussion with the defendant of the current case and charges.   

In Colorado the applicable test of insanity is, "A person who is so diseased or defective of mind at the time of the commission of the act as to be incapable of distinguishing right from wrong with respect to that act is not accountable.  But care should be taken not to confuse such mental disease or defect with moral obliquity, mental depravity, or passion growing out of anger, revenge, hatred, or other motives, and kindred evil conditions, for when the act is induced by any of these causes the person is accountable to the law."  (Colorado Revised Statutes 16-8.101(1)).

It is not an easy task to evaluate whether or not a person was insane at the time he or she committed the act.  It takes more than a psychological evaluation of the individual at the present time.  The Rogers Criminal Responsibility Assessment Scales (R-CRAS) was developed to provide a systematic and reliable model for evaluating clients for criminal responsibility.  Along with the customary clinical interviews and psychological testing, the R-CRAS provides clear descriptive criteria on scales measuring Patient Reliability, Organicity, Psychopathology, Cognitive Control, and Behavioral Control at the time of the alleged crime.

PATHS Center takes the time and the attention to detail, using state-of-the-art tools and techniques, in order to assess each individual and come to conclusions about his or her state of mind at the time of the act. 

A parenting evaluation may assist individuals in many different situations.  Of course, the issues of custody and visitation during and after divorce proceedings are the most obvious.  Other reasons one might want or need a parenting evaluation include:

• if your children have been placed in foster care;
• if Social Services has begun termination of parental right proceedings;
• if you are considering adoption of a special needs child.

We use a clinical interview (or multiple interviews if required), customary psychological testing, and reviews of collateral information to assess the level, style, and appropriateness of an individual's parenting skills and attachment.  We may also conduct parent/child interactional interviews to observe the parent and child together.

• For Individuals  Do you have an act or event in your history about which you do not want to lie on the application but will, without a doubt, make a potential employer blanch?  Was this act or event in your youth or during a time in your life that is so far removed that you know it will not occur again?  Be honest on your application.  Disclose the information and also present them with a psychological evaluation regarding you, your background, and your current risk and/or threat to people or property.  Prepare yourself for that interview and demonstrate your current level of responsibility and trustworthiness.
• For Employers
• Assess Job Candidates    Hiring the right employees is key to your business' success.  PATHS Center offers psychological testing which may help you improve your hiring effectiveness and select applicants who may be "a better fit" for your organization.
  

PATHS Center specializes in treatment of addictive disorders including the dually diagnosed.  We offer programs for advanced, or second stage recovery and specialty programs for professionals in recovery.  A support system is created through creating a team approach that includes the prescribing physician, the family, as well as the support of the therapy group dynamics.  For many in recovery from chemical dependence or other behavioral disorders, 12 Step programs will provide essential support during this process.

Dr. Mirich has been working with individuals who struggle with stubstance abuse and other addictions for the past 20 years.  His philosophy is that those recoving from substance abuse are in great need of structured support that includes addiction psychotherapy in concert with 12-step programs.  Adolescents can often become quite committed to a program of recovery and carry this into their adult years.  Additionally, even adults who have struggled with continual relapse often find that a new beginning can create long-term recovery.  At PATHS Center many individuals find success for the first time with their stuggles and begin the exciting journey toward lifelong recovery.

Sobriety Group - Adults - This support group is centered around maintaining abstinence from alcohol and drugs and is a powerful tool in recovery.  Relapse prevention and cognitive behavioral techniques are utilized in this facilitated therapy group. 

• Skills Group: - Teens - We will work on:  Communication Skills · Coping Skills · Relationship Skills · Social Skills · Problem Solving.  $60.00 per group.
• Sobriety Group - Teens - This support group is centered around maintaining abstinence from alcohol and drugs.  Relapse Prevention and Cognitive Behavioral techniques are utilized. $60.00.
• Internet Pornography / Sex Chat Psychotherapy: - Teens - Many people, including teens are rapidly becoming addicted to internet pornography and sex chat.  Dr. Patrick Carnes warns of an impending "tsunami" of out of control youth who are consuming increasingly large amounts of pornography.  Oftentimes youth will begin to substitute porn, compulsive masturbation and/or sexual acting out (physical or fantasy) for actual interaction with their significant others.  More and more often adolescents are utilizing myspace.com and ipods for storage and use of porn.  It is advisable to seek intensive psychotherapy at this early stage before the problem grows out of control. 

Dr. Mirich is a licensed psychologist specializing in the treatment of addictions and chemical dependency.  He is an advocate for medication assisted recovery and works closely with physicians in this area. Many of his patients are also receiving support from psychiatrists and addictionologists.  For those individuals involved in medication assisted recovery programs, the support of a structured psychosocial treatment regimen is key.  His  philosophy is facilitated support groups and individual addiction psychotherapy are essential tools for successful treatment outcomes.

A doctor may prescribe certain drugs to support recovery from addiction.  The drug can be a detoxifier, a stabilizer, an aversive agent, an antagonizing agent, or an anti-craving agent.  Other assistive drugs, such as antidepressants or mood stabilizers, include those used to lower risk of relapse via symptom suppression of one or more co-occurring physical or psychiatric disorders.

Common Signs of opioid dependence:

• Tolerance characterized by either:
  • a need for markedly increased amounts of the drug to achieve desired effect; or
  • markedly diminished effect with continued use of the same amount of the substance.
• Withdrawal, characterized by either:
  • dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, insomnia; or
  • the same or a closely related substance is taken to relieve or avoid withdrawal symptoms.
• The drug isoften taken in larger amounts or over a longer period than was intended.
• Persistent desire or unsuccessful efforts to cut down or control the drug use;
• A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance, or recover from its effects.
• Important social, occupational, or recreational activities are given up or reduced because of the substance use.
• The drug use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Dr. Mirich conducts a weekly sobriety group in which he accepts referrals for individuals with chemical dependency, including those treated with Camprol, Vivitrol, Revea and Antabuse.  He has attended the comprehensive, full day buprenorphine training and works closely with physicians with experience in medication assisted treatment with Suboxone.  He is very much a proponent of the treatment. He has added a buprenorphine treatment group to his practice in which referrals to the group will be limited to those receiving Suboxone.

Additionally, PATHS Center is able to call in patients for random pill counts and random urine drug screens.  We perform the urinalysis at cost ($9.00), as a service to physicians and their patients. 

Weekly support groups at PATHS Center include:

• Buprenorphine group.
• Sobriety group is open to referred individuals with chemical dependency, including those treated with Suboxone, Camprol, Vivitrol, Revea and Antabuse, as well as those individuals in medication-free recovery.
• Alcoholics Anonymous meeting for Medical and Mental Health Professionals
• Prescriptions Anonymous meeting

Please see the calendar for meeting schedules

Many individuals who experience chronic pain take medication that could possibly lead to addiction or physical dependence. What do we mean when talking about "addiction" and "dependence"? The American Academy of Pain Medicine, The American Pain Society, and the American Society of Addiction Medicine published a consensus document which contained the following definitions:

• Addiction is a primary, chronic neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations.  It is characterized by behaviors that include one or more of the following:  impaired control over drug use, compulsive use, continued use despite harm and craving.
• Physical Dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
• Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
• Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated.  Patients with unrelieved pain may become focused on obtaining medications, may "clock watch," and may otherwise seem inappropriately "drug seeking."  Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief.  Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated.

Research shows that overall, evidence of addiction is exceedingly rare during long-term opioid treatment of cancer pain and does not commonly occur among patients with no history of abuse who receive opioids for other medical indications.  However, there are also other statistics that show an increase in the use of prescription pain relievers for nonmedical reasons:

• In 2002, almost 30 million persons aged 12 or older (13 percent) had used prescription pain relievers nonmedically in their lifetime.
• The numbers of persons using prescription pain relievers nonmedically for the first time increased from 600,000 in 1990 to more than 2 million in 2001
• About 1.5 million persons aged 12 or older were dependent on or abused prescription pain relievers in 2002
• Statistics taken from the National Survey on Drug Use and Health: Nonmedical Use of Prescription Pain Relievers http://www.oas.samhsa.gov/2k4/pain/pain.htm

The result:  rare ≠ never   There are individuals who have become addicted to their pain medication;  There are also those who have a history of substance abuse and are rightfully concerned about their use of pain medication; And finally, there are those too who are using pain medication to feed their addiction(s). 

If you or your patient is dealing with these or related issues come join one of our groups or schedule an individual appointment and avail yourself to the support of therapy.  Together with your physician we can work through the pain/addiction questions and arrive at a solution for your problems.