3.6.3.60 Guidelines to Table 6 - Functioning related to Alcohol, Drug & Other Substance Use

Summary

Table 6 is used where a person has a functional impairment due to excessive use of alcohol, drugs or other harmful substances or the misuse of prescription drugs.

Excessive use means problematic use that results in damage to a person's mental or physical health.

Harmful substances are those which on taking them result in damage to a person's mental or physical health for example, glue or petrol sniffing.

The problematic use of prescription drugs in a manner other than prescribed by a medical practitioner, and the problematic use has resulted in a permanent functional impairment.

The essential feature of a substance use disorder is a cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.

An appropriately qualified medical practitioner must make the diagnosis of the condition. This includes a GP or medical specialist such as an addiction medicine specialist or psychiatrist with experience in diagnosis of substance use disorders.

Table 6 applies only to people who have current, continuing alcohol, drug or other harmful substance use disorders and those in active treatment.

People who suffer from long-term impairment that has resulted from previous alcohol, drug or other substance use but who no longer have an active substance use disorder and are no longer receiving active treatment must be assessed under the other relevant tables and not Table 6. For example, if the person has a resulting brain injury, they should be assessed under Table 7 - Brain Function. Similarly, if a person had resulting chronic liver disease they should be assessed using Table 10 - Digestive and Reproductive Function.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining functional impacts of the person's permanent condition (impairment). There must be corroborating medical evidence of the person's impairment.

Regardless of the number of substances the person is dependent on only one rating is to be assigned under Table 6 to reflect the overall functional impairment.

Determining the level of functional impact

When determining which impairment rating applies to a person the rating that best describes the person's abilities or difficulties must be applied. In applying the descriptors in Table 6, each descriptor sets out how the points within it are to apply.

For example, the 5-point descriptor states 'at least one of' the following descriptor points applies. The 10-point descriptor states 'most of' the following apply. It also applies to people receiving treatment who are in sustained remission and are able to complete most activities of daily living. Under the 20 and 30-point descriptors, 'most of' the descriptors must apply.

Where the descriptor refers to most of the following, most is taken to be more than half of the number of descriptor points for that impairment rating. For example, at the 10-point level, 'most' would be taken as at least 3 out of 5 descriptors applying and so on for the 20 and 30-point descriptors.

The structure of the tables requires that, in assessing the level of functional impact, a comparison must be made of all the descriptors for each level of impairment. An assessment starts by considering the descriptors for 0 points, and if a person has more than 'no functional impact', the descriptors for 5 points are then considered, and so on for the descriptors for higher impairment levels. When it is determined that the person meets all the required descriptors for a certain impairment rating level, but does not meet all the required descriptors for the next impairment rating level, the appropriate impairment rating applicable to the person's circumstances will be the lower of those 2 impairment ratings (i.e. the rating at which all the required descriptors are met).

Note: Individual descriptors or their parts must not be applied in isolation from one another.

In determining whether the required descriptors for a specific impairment level are met or not, ALL the descriptors for that level must be considered and applied as set out in the descriptor. NO descriptors or their parts are to be disregarded. One of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors.

Determination of the descriptor that best fits the person's impairment level must be based on the available medical evidence including the person's medical history, investigation results and clinical findings. A person's self-reported symptoms MUST NOT SOLELY BE RELIED ON. It would be inappropriate to apply an impairment rating based solely on a person's self-reported functional capacity if the level of functional impairment is not consistent with the medical evidence available.

High levels of intake will increase health risks but the use of alcohol, drugs or other harmful substances in itself does not necessarily indicate significant and permanent functional impairment. For example, a person with a high level of alcohol intake may not have developed any medical complications or experienced significant problems in how they function. Each person should be assessed on an individual basis, as the level of impairment cannot be predicted from the reported level of drug or alcohol use alone. It should not be assumed, for example, that a person on a methadone program is severely functionally impaired and has no work capacity.

If reasonable treatment has not been undertaken, it should be considered whether the person has a medical or other compelling reason for not doing so. For example, due to their condition, the person may have insufficient insight and ability to make sound judgements and this may therefore affect their compliance with recommended treatment. As such a person's impairment could then be considered fully stabilised and permanent for DSP purposes if it is unlikely to improve significantly within 2 years.

However, in cases where the person is considered to retain sufficient insight and judgement and their decision not to undertake reasonable treatment is not due to a medical or other compelling reason, the condition cannot be regarded as fully treated and stabilised even if significant improvement could be expected to occur with reasonable treatment.

When determining a person's limitations in relation to conducting 'work tasks', this is taken to refer to any job available in Australia.

0-point impairment rating level

The 0-point descriptor specifies that the person has NO functional impact from alcohol, drugs or other harmful substance use. The person can carry out all activities in descriptor (1).

5-point impairment rating level

The 5-point descriptor specifies that there is a MILD functional impact from alcohol, drugs or other harmful substance use.

For this rating to be assigned to a person, AT LEAST ONE of the descriptors (1)(a), (b) and (c) must apply. Additionally, if point (c) were to apply, a person would be expected to be able to sustain employment or training activities without excessive absences (i.e. no more than approximately 30 days total absence across a 6-month period.)

10-point impairment rating level

The 10-point descriptor specifies that there is a MODERATE functional impact from alcohol, drugs or other harmful substance use.

For this rating to be assigned to a person, MOST of the descriptors (1)(a), (b), (c), (d) and (e) must apply.

The 10-point descriptor also states that this rating level includes a person in receipt of treatment and in sustained remission who is able to complete most activities of daily living. To meet the 10-point descriptor, if a person meets (2) there would also need to be a moderate functional impact from harmful substance use or from the side effects of opiate replacement therapy treatment such as methadone and the person would also need to meet descriptor (1).

20-point impairment rating level

The 20-point descriptor specifies that there is a SEVERE functional impact from alcohol, drugs or other harmful substance use. For this rating to be assigned to a person, most of the descriptors (1) (a), (b), (c), (d), and (e) must apply.

30-point impairment rating level

The 30-point descriptor specifies that there is an EXTREME functional impact from alcohol, drugs or other harmful substance use. For this rating to be assigned to a person, MOST of the descriptors (1) (a), (b), (c), and (d) must apply.

Some conditions causing impairment commonly assessed using Table 6

These include but are not limited to:

• alcohol use disorder
• various illicit drug use disorders and
• various inhalant use disordersvarious prescription drug use disorders.

Impairments that should not be assessed using Table 6

Long term impairments that result from alcohol, drug or other substance use, can include neurological or cognitive impairment, cirrhosis or other chronic liver disease, pancreatitis or other complications of end organ damage. To avoid double counting, these resulting conditions should be assessed under the appropriate table according to the area of function affected.