Driver’s License Restoration in Michigan – The Diagnosis in a Substance Abuse Evaluation – Part 1

In the previous 2-part article, we began a rather detailed examination of the “Testing Instruments” section of the Substance Abuse Evaluation that must be completed and filed as part of any Driver’s License Appeal. In that article, we noted that, quite logically, the result of that Alcohol Evaluation Test is a “Diagnosis.” This article will bring that whole “Diagnosis” section under the lens for another in-depth analysis. Part 1 and part 2 of the preceding article should be read as a pre-requisite to this one. In this article, we’ll analyze the Diagnosis that results from whatever Test is given, and analyzed in the prior set of articles.

These “fine-tooth comb” type of articles are for people, like me, who are interested in details. Within the body of the Driver’s License Restoration section of this blog, I have all kinds of articles that range from a summary overview of License Appeals, to a more specific analysis of the process, all the way to articles like these, which provide a nearly microscopic analysis of just one component of that process. As I noted before, I find that many of my Clients are interested in the fine points and minutia, and that’s a good thing. Beyond the mere desire and willingness to learn, this helps provide me with a Client base that is considerably more well-read and intelligent than average.

Diagnosis5.jpgInterestingly, if not ironically, the Diagnosis section of the Substance Abuse Evaluation comes before the Testing Instruments section. This is a little bit of the-cart-before-the-horse in terms of layout, but beyond being a bit illogical, it does not change the fact that the Diagnosis is the result of whatever Alcohol Assessment is administered.

The range of possible Diagnoses is not particularly broad. Essentially, after taking an Alcohol Assessment Test, a person can only get 1 of 3 rather general diagnoses:

  1. “no diagnosis” (meaning no alcohol problem),
  2. “alcohol abuse,” or
  3. “alcohol dependence.”

Within these broader categories, there are a few sub categories: A person can be either an early, or late-stage alcohol abuser; alcohol dependent, or chronically (meaning late stage, or longstanding) alcohol dependent. These sub-categories are seldom used in License Appeal Substance Abuse Evaluations, however, so we’ll omit any discussion of them.

In the real world, a “no diagnosis,” meaning “no alcohol problem” diagnosis almost never occurs. In fact, even if such a diagnosis were reached in any particular case, the Secretary of State’s Driver Assessment and Appeal Division (DAAD) would have grave doubts about it. This is because it is pretty much assumed that anyone with 2 or more DUI’s has some kind of alcohol problem. This means that there are really only 2 plausible and realistic diagnoses: Alcohol Abuse, or Alcohol Dependence.

Those Diagnoses refer to the various stages of an alcohol problem. However, a person can have been an alcohol abuser who has been sober, and committed to that Sobriety for a number of years, and therefore be considered in “Sustained Full Remission.” Conversely, a person can be diagnosed as alcohol dependent, but still drinking. These degrees of Recovery, or lack thereof, within any specific Diagnosis are called “Course Specifiers.” If you look at the actual Substance Abuse Evaluation form, you will see that there are 8 such categories, and that a specific “Course Specifier” is required to be checked right beneath the person’s Diagnosis. While I could write a textbook about this subject alone, the only thing that really matters is that a person be found to have “Sustained Full Remission” or “Full Recovery” (or, in some cases, both). Anything else (essentially meaning anything less) will result in an automatic Denial of a License Appeal.

The fact that the DAAD sees things this way give us our first peek into why this section of the Substance Abuse Evaluation, which in practice can only result in 1 of 2 Diagnoses, is so important, and requires so much micro-analysis.

As I pointed out in the previous set of articles, the DAAD Hearing Officers are experts at this stuff. They spend all day, every day, reading Substance Abuse Evaluations, and are well-educated in the nuances of Alcohol Assessments and their attendant results.

It is this expertise that allows them to spot anomalies between the Alcohol Assessment Test, its results, and the Diagnosis ultimately reached.

And this can be a really big can of worms.

It seems only sensible that anyone taking an Alcohol Assessment Test would prefer to get a less-serious, alcohol abuse diagnosis, rather than the more serious, alcohol dependence diagnosis. This is really a question of “staging.”

If you have any kind of problem, you would hope that it is found and fixed earlier rather than later. Alcohol problems are no different. At first blush, it seems more likely that a person with a decades-long alcohol dependence problem will have a harder time, and is therefore a more guarded bet, to get and stay sober than someone who has a much shorter-term alcohol abuse problem. While there is some truth to this rather general proposition, it is a generalization that can be misleading, especially as it relates to getting sober.

Interestingly, it is not nearly as important which of the 2 Diagnosis (alcohol abuse versus alcohol dependence) a person receives as one might at first suspect. In fact, aside from a number of logistical concerns about the kind of treatment undertaken for either an alcohol abuse or alcohol dependence problem, the largest concern is that the Diagnosis is accurate.

The first thing the DAAD is going to look at about any Diagnosis reached as a result of an Alcohol Assessment Test is that it is correct. It sounds like a bit of an oversimplification, but it is of paramount importance that the actual Diagnosis given as a result of whatever Testing Instrument used is accurate.

This become even more problematic when certain tests, like the MAST Test, is used. For over 30 years, there has been debate and discussion about how to “score” an alcohol problem when administering the MAST Test. Different clinicians can, and do, score the test results differently. This means that, for all of the discussion we could have about this subject, a person who scores 4 points on this test can be diagnosed as either “non-alcoholic,” or can likewise be diagnosed as an “early or middle problem drinker.” In other words, the same score can result in a different diagnosis, depending on the mindset of the Evaluator.

The DAAD, however, has its mind made up about certain things, and perhaps foremost amongst them is that anyone with 2 or more DUI’s has a drinking problem. I would not, for all the money in the world, undertake a License Appeal where a person scored 4 points on a MAST Test, received a “non-alcoholic” diagnosis, and then go in a try to argue that the Client has no alcohol problem. I have yet to meet the Hearing Officer who would agree with that, and am certain that any such strategy is a sure-fire loser, at least in the Livonia Office where all my Driver’s License Appeal Hearings are held..

Thus, it is extremely important for the Lawyer undertaking License Appeal Representation to have a very good working knowledge of these concepts and principles. In fact, it had better be a person’s Lawyer who spots these anomalies first, and not the Hearing Officer, lest a Denial of the License Appeal result.

This, in turn, is why I generally refer my Clients to a particular Clinic right by my Office. If that’s not convenient, I have a handful of other places that I can recommend. In my 20-plus years of handling License Appeals, I have seen too many flawed Substance Abuse Evaluations to count, and have only seen that relatively small handful of Evaluators who consistently do a good job. And by “good job,” I mean a high degree of integrity and thoroughness, and not merely trying to say what they think might be helpful to the person being evaluated. In fact, the DAAD expects the Evaluation to be as clinical, objective and un-colored as an x-ray. If it turns out to be anything less, than it is no longer an asset to a License Appeal, and becomes a liability, instead.

In part 2 of this article, we’ll look beyond the mere accuracy of the Diagnosis received as a result of the Testing Instrument, and see how a person’s “test-taking attitude,” or “Defensiveness” score in taking the test can be every bit as important as the Diagnosis itself.