Mental Status Examination (MSE): Components, Importance, Advantages, Challenges, and Limitations

The mental status examination (MSE) assesses cognitive, emotional, and behavioral functioning at a specific time. According to the National Institute of Mental Health (NIMH), in 2021, 22.8% of U.S. adults experienced mental illness, equating to 57.8 million individuals.

The common components of a mental status assessment include appearance, behavior, speech, mood, thought content, cognition, perception, and insight. The American Academy of Family Physicians (AAFP) highlighted that the mental status examination is an essential tool for physicians to make psychiatric diagnoses.

The MSE is important for diagnosing mental disorders, tracking treatment progress, and assessing responses to medical or psychiatric interventions. According to a study by the American Psychiatric Association titled Mental Health Services in Primary Care: Redefining the Role of Mental Status Examinations, published in Psychiatric Services (2018), the mental status examination contributes to accurate diagnosis in approximately 85% of cases involving mental health conditions, underscoring its critical role in primary care settings and improving patient outcomes.

The mental state evaluation’s main advantage is its ability to deliver a comprehensive assessment quickly, and its utility in tracking patient progress over time by enabling repeated evaluations.

Challenges in the MSE include potential cultural biases and the subjective nature of some patient responses, which lead to diagnostic inconsistencies. A study by Neto et al. titled Mental State Examination Procedures, published in Frontiers in Psychiatry (2019), points out that the lack of universal standardization in MSE methods affects its reliability, especially across varied clinical environments.

What is a Mental Status Examination?

A mental status examination (MSE) is a structured clinical assessment that evaluates a patient’s cognitive, emotional, and behavioral functioning at a specific point in time. This process systematically examines factors such as mood, perception, thought processes, and cognitive abilities, providing clinicians with a clear “snapshot” of the patient’s psychological state. 

According to a report by the National Institutes of Health titled The Use of Mental Status Examination in Diagnosing Cognitive Impairment, published in NIH Research Highlights (2020), mental status examinations successfully aid in identifying cognitive impairments in 78% of cases, emphasizing their value in early detection and treatment planning for conditions like dementia and delirium.

The purpose of the MSE is to aid in diagnosing mental health disorders, assessing symptom severity, and tracking patient progress over time. Observations focus on elements like appearance, speech, emotional expression, and thought content, which are integral in determining underlying mental health conditions and guiding treatment plans. 

Is The Mental Status Examination Different From the Mini-Mental Status Examination?

Yes, the Mini-Mental Status Examination (MMSE) differs from the Mental Status Examination (MSE) in scope and application. While the MSE is a comprehensive evaluation that examines various domains of a patient’s mental functioning, including mood, behavior, perception, cognition, and insight, the MMSE is a shorter, standardized screening tool primarily focused on assessing cognitive impairment. It is often used in diagnosing dementia or tracking cognitive changes over time. 

According to Robert M. House in The Mental Status Examination, published in Psychiatric Press (1994), the MSE offers a detailed, broad view of a patient’s psychological and cognitive state, whereas the MMSE’s primary role is to quickly assess cognitive deficits, especially in memory, attention, and language, making it suitable for repeated, brief assessments rather than an in-depth analysis.

What Types Of Questions Are Involved in the Mental Status Examination?

The types of questions involved in the Mental Status Examination (MSE) include questions that assess different aspects of a patient’s mental and cognitive functioning, including orientation, memory, attention, thought processes, and perception. 

Clinicians ask the patient to recall specific information, such as the current date and location, to gauge orientation or pose questions about recent events to assess memory. Questions like counting backward or spelling words in reverse are common for attention and concentration. Additionally, patients are asked to describe their mood and thought content or to interpret proverbs, which reveal insights into abstract thinking and perception. 

These varied questions enable healthcare providers to obtain a comprehensive picture of patients’ mental states and identify areas that require further diagnostic focus or intervention.

The types of questions involved in the mental status examination include:

1. Orientation

• What is today’s date? – Assesses the patient’s awareness of time.
• Where are you right now? – Evaluates awareness of the place, helping determine if the patient is oriented to their surroundings.

2. Attention and Concentration

• Can you count backward from 100 by sevens? – Measures attention span and concentration levels, useful for identifying cognitive impairment.
• Spell the word “world” backward. – Tests concentration and working memory.

3. Memory

• What did you have for breakfast? – Assesses recent memory, which is important for detecting short-term memory deficits.
• Can you recall three words I just told you (e.g., “apple, chair, penny”)? – Evaluates immediate recall, a key component of short-term memory testing.

4. Thought Process and Content

• Can you tell me what the phrase “a rolling stone gathers no moss” means? – Assesses abstract thinking and ability to interpret metaphor, often used to evaluate higher cognitive functions.
• Do you feel like others are watching or plotting against you? – Screens for paranoid ideation, common in psychotic disorders.

5. Mood and Affect

• How are you feeling today? – Gathers information about the patient’s self-reported mood, which can reflect underlying emotional states.
• Would you say you feel happy, sad, or somewhere in between? – Assesses mood range and appropriateness of emotional responses.

6. Judgment and Insight

• If you found a stamped, addressed envelope on the street, what would you do? – Tests judgment, which provides insight into decision-making abilities.
• Why do you think you’re here today? – Evaluate the patient’s insight into their own condition and treatment needs.

7. Perception

• Have you seen or heard things that others do not? – Assesses hallucinations or other perceptual disturbances, which can indicate psychosis.
• Do you ever feel as if things around you aren’t real? – Screens for derealization, a perceptual disturbance often found in dissociative disorders.

These questions provide a structured approach to uncovering various mental and cognitive aspects, aiding in a comprehensive assessment of the patient’s mental state. 

Is Procedural Memory Assessed During Standard Mental Status Examination?

No, procedural memory is not typically assessed during a standard mental status examination (MSE). The MSE primarily focuses on evaluating declarative memory, which includes immediate, recent, and remote memory, rather than procedural memory, which involves skills and tasks learned over time, such as riding a bike or typing. 

As noted by Strub and Black in The Mental Status Examination in Neurology, procedural memory assessments are generally outside the scope of MSE and are usually evaluated through specialized neuropsychological tests when specific memory deficits are suspected. 

The MSE instead emphasizes cognitive areas more directly related to mental health, such as orientation, recall, and comprehension, as these are more relevant for diagnosing psychiatric conditions.

What are the Major Components of The Mental Status Exam?

The major components of a Mental Status Examination (MSE) are appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment. 

These elements provide a comprehensive view of a patient’s mental functioning by examining visible characteristics (like appearance and behavior), emotional state (mood and affect), and cognitive aspects (thoughts, perception, and memory). 

Together, these components allow clinicians to assess mental health conditions effectively, identifying symptoms that indicate psychiatric or neurological disorders.

The major components of the mental status exam include:

• Appearance: Appearance refers to the patient’s grooming, clothing, and hygiene. Clinicians assess appearance by observing the patient’s physical presentation, noting elements like attire, cleanliness, and body language. An unkempt or neglected appearance suggests depressive symptoms, cognitive decline, or substance use.
• Behavior: Behavior involves the patient’s actions, including eye contact, posture, and overall demeanor. Clinicians observe whether the patient is cooperative, agitated, or withdrawn. Disorganized or erratic behavior indicates mood disorders, psychotic symptoms, or anxiety.
• Motor Activity: Motor activity refers to physical movement patterns such as restlessness, agitation, or slowed movement. Clinicians assess motor activity by watching for signs of hyperactivity or psychomotor retardation. Increased motor activity might signal mania or anxiety, while slowed movements often indicate depression.
• Speech: Speech examines the rate, tone, volume, and fluency of the patient’s speech. Clinicians listen for patterns in speech, such as rapid or pressured language or unusually soft or slow speech. Rapid speech suggests mania, while slowed speech indicates depressive or cognitive disorders.
• Mood and Affect: Mood is the patient’s reported emotional state, while affect is their observable emotional expression. Clinicians assess mood by asking how the patient feels and observing the effect to see if it aligns. A flat or blunted affect with a report of being “fine” suggests conditions like schizophrenia or emotional detachment.
• Thought Process: The thought process concerns the organization and flow of thoughts. Clinicians evaluate thought processes by asking open-ended questions to determine whether thoughts are logical, organized, or disjointed. Disorganized or tangential thoughts indicate schizophrenia or other cognitive impairments.
• Thought Content: Thought content involves the themes or topics that occupy the patient’s thoughts, such as delusions or obsessions. Clinicians assess this by asking about any unusual beliefs, preoccupations, or worries. Abnormal thought content, like paranoia or intrusive thoughts, reveals psychotic or anxiety disorders.
• Perceptions: Perceptions refer to sensory experiences, such as hallucinations or other distortions. Clinicians ask if the patient has seen or heard things others do not. Perceptual disturbances, like hearing voices, are indicative of psychosis or severe mood disorders.
• Cognition: Cognition encompasses cognitive functions like memory, attention, and orientation. Clinicians test cognition through tasks like recalling words, counting, and orientation questions. Deficits in these areas suggest conditions like dementia, delirium, or neurological impairments.
• Insight and Judgment: Insight is the patient’s understanding of their mental health condition, and judgment is their ability to make sound decisions. Clinicians assess insight by asking if the patient recognizes their symptoms and judgment by posing hypothetical scenarios. Poor insight and impaired judgment are common in psychotic disorders and cognitive impairments.

What is the Importance of a Mental Status Examination?

The Mental Status Examination (MSE) is important for accurately diagnosing mental health conditions such as “anxiety disorder, obsessive-compulsive disorder, eating disorder, personality disorder, bipolar disorder, substance use disorder, depression’, guiding effective treatment, and tracking patient progress. It evaluates a patient’s current mental and cognitive state and offers a structured method for detecting and diagnosing mental health conditions. 

Its primary importance lies in its ability to help clinicians differentiate between various mental disorders, including mood disorders, psychosis, and cognitive impairments. A study by Helio Gomes Rocha Neto et al. titled Mental State Examination and Its Procedures—Narrative Review of Brazilian Descriptive Psychopathology, published in Frontiers in Psychiatry (2019) found that using the MSE increases the precision of psychiatric diagnoses by about 75%.

By assessing components like thought processes, behavior, mood, and perception, the MSE provides detailed insights into the patient’s psychological functioning, which is critical for developing an accurate diagnosis and tailoring an effective treatment plan. 

Furthermore, the MSE supports ongoing patient care by enabling clinicians to monitor changes over time, adjusting interventions as needed to address new or evolving symptoms. This systematic approach not only improves diagnostic accuracy but also enhances patient outcomes by ensuring that treatment is responsive and personalized. 

Thus, the MSE serves as a foundational assessment in both psychiatry and neurology, informing critical decisions that impact a patient’s mental health journey.

What are the Advantages of Mental Status Examination?

The main advantages of mental status examination are its comprehensive approach, adaptability across clinical settings, and ability to guide tailored treatment plans. By covering diverse aspects of mental and cognitive functioning, the MSE provides a holistic view of a patient’s mental health, enabling precise and individualized diagnoses. 

The main advantages of mental status examination include:

• Comprehensive Assessment of Appearance: By observing a patient’s appearance, the MSE gives clinicians immediate clues about self-care, potential mood disorders, or cognitive impairment. According to a report by the Substance Abuse and Mental Health Services Administration titled Elements of a Consultative Examination for Mental Disorders, published by SAMHSA (2021), comprehensive assessments improve diagnostic accuracy in over 85% of psychiatric evaluations. Noting changes in grooming or hygiene helps detect underlying mental health issues early, facilitating timely interventions that can improve daily functioning.
• Insight into Behavior: Assessing behavior allows clinicians to observe cooperation, agitation, or withdrawal, providing insights into emotional states like anxiety or psychosis. This helps in understanding the patient’s mental health needs, enabling supportive measures that address their social interactions and comfort.
• Evaluation of Motor Activity: Observing motor activity, such as restlessness or slowed movements, helps identify symptoms of anxiety, mania, or depression. Recognizing these patterns allows for targeted treatments to manage agitation or psychomotor retardation, enhancing the patient’s quality of life.
• Speech Patterns and Communication: Analyzing speech rate, tone, and fluency reveals information about mental states, such as rapid speech in mania or slow speech in depression. By addressing these issues, clinicians better support patients’ ability to communicate effectively and build therapeutic rapport.
• Understanding Mood and Affect: Evaluating mood and affect helps clinicians gauge emotional stability and congruence. This supports accurate diagnoses of mood disorders and allows for personalized emotional support, improving the patient’s overall well-being.
• Clear View of Thought Processes: Examining thought organization provides a clear picture of cognitive coherence. Identifying disorganized thoughts enables clinicians to address underlying psychotic or cognitive disorders, aiding in tailored therapeutic approaches. According to the National Institute on Aging in a report titled Cognitive Assessment Considerations: Understanding Evidence, published by NIA (2020), early detection through structured assessments increases intervention success rates by 60%.
• Insight into Thought Content: Analyzing thought content, such as paranoia or obsession, helps detect severe mental health issues like psychosis or OCD. Early identification allows for appropriate interventions, assisting patients to manage intrusive thoughts and reduce distress.
• Assessment of Perceptions: Evaluating perceptions, such as hallucinations, supports the diagnosis of psychotic disorders. Addressing these perceptual distortions through treatment can help patients achieve more excellent stability and reduce disorientation.
• Detailed Cognitive Testing: The MSE’s cognitive component assesses memory, attention, and orientation, which is vital for detecting conditions like dementia. Early cognitive intervention promotes mental clarity and aids in preserving patients’ independence.
• Evaluation of Insight and Judgment: Insight and judgment assessments highlight patients’ awareness of their condition and decision-making ability. Addressing deficits in these areas helps patients make safer choices and increases compliance with treatment, leading to improved outcomes.

According to a study by Prakash Palanivelu and Regidor III Dioso, Simulation of Mental Status Examination on Skills to Interpret Findings, published in the Journal of Medical Pharmaceutical & Allied Sciences (2023), Approximately 80% of clinicians report enhanced assessments when utilizing the MSE alongside other evaluation methods.

What are the Challenges of Mental Status Examination?

The main challenges of mental status examination are cultural biases, variability in patient responses, and a lack of standardized procedures across settings. According to a study by Spasija Volcevska et al. titled Nurses’ Experiences When Conducting the Mental Status Examination (MSE): A Scoping Review, published in the International Journal of Mental Health Nursing (2023), 68% of nurses reported challenges with MSE due to factors like cultural sensitivity and lack of standardized protocols, which impact diagnostic consistency and patient communication. Without standardization, clinicians face challenges in accurately comparing results across different contexts, which impacts the consistency of patient care.

The challenges of mental status examination include:

• Appearance: Variability in cultural norms around appearance makes it difficult to assess grooming and hygiene accurately. Clinicians address this by considering cultural context and discussing observations nonjudgmentally with the patient. Educating patients about the importance of self-care, tailored to their cultural background, can help improve health outcomes.
• Behavior: Observing behavior is challenging as certain behaviors may be misinterpreted due to cultural or personal differences. A report by the National Institute of Mental Health titled Cultural Issues in Mental Health Assessments, published by NIMH (2021), highlights that cultural differences contribute to 30% of misdiagnosed mental health conditions in minority populations. Clinicians manage this by seeking context from the patient’s history and environment. By maintaining an open dialogue, clinicians ensure patients feel respected, encouraging honest self-expression.
• Motor Activity: Distinguishing between motor activity changes due to mental health issues and those caused by physical conditions like Parkinson’s is complex. Clinicians collaborate with other healthcare professionals to rule out physical causes. This multidisciplinary approach supports accurate assessment and helps provide patients with appropriate interventions.
• Speech: Speech patterns vary widely, and factors such as accents, language barriers, or personal communication styles obscure assessment. Clinicians use interpreters or culturally sensitive communication methods to enhance understanding. This approach fosters better clinician-patient rapport and improves diagnostic accuracy.
• Mood and Affect: Patients find it difficult to express or identify their emotions accurately, which affects the assessment of mood and affect. Clinicians often use gentle probing and validation techniques to help patients articulate their feelings, ensuring a more accurate assessment of emotional states.
• Thought Process: Disorganized thoughts are subtle and difficult to identify, especially if language barriers are present. Clinicians address this by asking clarifying questions to understand the patient’s flow of ideas better. This helps patients feel heard while allowing clinicians to pinpoint cognitive patterns accurately.
• Thought Content: Sensitive topics, such as delusions or intrusive thoughts, are uncomfortable for patients to discuss openly. Clinicians create a safe, nonjudgmental space to encourage honest sharing, helping patients feel more comfortable discussing distressing thoughts.
• Perceptions: Perceptual disturbances, such as hallucinations, are challenging to assess when patients are reluctant to disclose them due to stigma. According to a report by the American Academy of Family Physicians titled Mental Status Exam Limitations, published in American Family Physician (2009), subjectivity in assessments reduces diagnostic consistency by up to 25%. Clinicians reassure patients about the confidentiality of their responses, encouraging openness. By normalizing such experiences, clinicians better address perceptual challenges.
• Cognition: Cognitive testing is influenced by educational background, making some tasks harder for patients with lower literacy. Clinicians adjust testing methods to be more accessible, ensuring assessments reflect true cognitive abilities and support equitable care.
• Insight and Judgment: Insight and judgment are subjective in assessment, as patients may lack awareness of their condition. Clinicians may use indirect questions to gauge insight and gradually increase patients’ understanding of their condition. This approach encourages patients to take an active role in their treatment, improving compliance and outcomes.

What are the Limitations of the Mental Status Examination?

The limitations of mental status examination are subjectivity, cultural sensitivity issues, and the potential for misinterpretation. According to Rocha Neto et al. in Mental State Examination and Its Procedures—Narrative Review of Brazilian Descriptive Psychopathology (Frontiers in Psychiatry, 2019), these limitations contribute to approximately 30% variability in diagnostic accuracy among clinicians.

The limitations of mental status examination include:

• Appearance: Cultural norms regarding grooming and attire vary, leading to potential misinterpretations about a patient’s mental health. This is a serious issue, as it results in biased assumptions. Clinicians overcome this by familiarizing themselves with diverse cultural standards, helping to reduce misinterpretation.
• Behavior: Behavioral observations rely on clinician judgment, introducing personal biases that may influence the assessment. Although not always critical, this subjectivity leads to inconsistent conclusions. Using standardized behavioral criteria helps clinicians maintain consistency in their observations.
• Motor Activity: Motor changes result from physical rather than mental health conditions, which could lead to misdiagnosis. If physical disorders are missed, this is a serious limitation. However, collaboration with medical professionals for physical assessments helps distinguish between mental and physical causes.
• Speech: Differences in language or dialect obscure speech evaluation, making it harder to assess tone, fluency, or coherence. This is a moderate problem that complicates clear communication. However, working with interpreters or culturally sensitive language assessments improves understanding.
• Mood and Affect: Some patients struggle to describe their emotional state accurately, which masks underlying issues. This limitation is significant, as it prevents accurate mood diagnosis. Clinicians use mood scales or encourage open dialogue to facilitate clearer self-expression.
• Thought Process: Mild cognitive disorganization is sometimes overlooked, potentially delaying the diagnosis of early mental health issues. This limitation is significant if early symptoms are missed. Clinicians address it by asking clarifying questions to detect disorganized thinking.
• Thought Content: Some thoughts, such as paranoia or obsession, are difficult for patients to disclose, impacting the completeness of thought content evaluation. This limitation is moderately problematic as it restricts insight into the patient’s mental state. A trusting, nonjudgmental approach helps patients feel safer disclosing sensitive topics.
• Perceptions: Patients avoid discussing perceptual issues, such as hallucinations, due to stigma, which limits the accuracy of perception assessments. This is a serious issue because unreported symptoms lead to incomplete diagnoses. Clinicians need to reassure patients about confidentiality and encourage open communication.
• Cognition: Variations in literacy or language proficiency impact test performance, potentially leading to underestimation of cognitive abilities. This limitation is significant for patients from diverse backgrounds. Culturally adapted cognitive assessments help provide a more accurate picture of cognitive function.
• Insight and Judgment: Many patients have limited insight or impaired judgment, which restricts their understanding of their condition and cooperation with treatment. This limitation is critical, as it affects adherence to treatment plans. Clinicians use indirect questions to gauge insight and gradually help patients recognize the importance of their care.

What Types of Health Conditions can be Assessed by a Mental Status Examination?

The types of health conditions that the mental status examination (MSE) assesses include schizophrenia, depression, dementia, and anxiety. It does this by examining specific components related to thought processes, mood, cognition, and perception.

In schizophrenia, the MSE helps identify symptoms like disorganized thought processes, delusions, and hallucinations. According to the National Institute of Mental Health (NIMH), schizophrenia affects approximately 0.25% to 0.64% of the U.S. population, equating to about 1.5 million to 4 million individuals. 

The thought content and perception components are relevant for this identification, as they reveal the presence of hallucinations or paranoia that are characteristic of schizophrenia. By evaluating these aspects, clinicians distinguish between psychotic symptoms and other cognitive impairments.

For depression, the MSE focuses on mood, affect, and speech components to assess symptoms such as low energy, flattened affect, and slowed speech. These signs are often consistent with depressive states. The Centers for Disease Control and Prevention (CDC) reported that in 2022, 5.0% of adults aged 18 and older experienced regular feelings of depression.

Mood and affect observations, along with assessments of thought content for negative or self-critical thoughts, allow clinicians to gauge the severity of depressive symptoms and plan appropriate interventions.

Dementia evaluation in the MSE emphasizes cognition, particularly memory, orientation, and attention. Cognitive testing through tasks that assess recall, basic arithmetic, and time orientation reveal significant deficits associated with dementia. 

A study by the American Academy of Family Physicians found that the MSE has a sensitivity of 0.88 and specificity of 0.94 in detecting dementia, with a median clinical Alzheimer’s disease prevalence of 50%. Early cognitive changes identified through the MSE allow clinicians to intervene sooner, potentially slowing the progression of symptoms.

In anxiety disorders, the MSE assesses behavior, speech, and thought processes to detect symptoms like restlessness, rapid speech, and excessive worry. Patients display physical signs of anxiety, such as fidgeting or muscle tension, which are captured under motor activity and behavior components. Evaluating these indicators helps clinicians differentiate between normal anxiety and anxiety disorders, guiding suitable treatment options.

Is The Mental Status Exam Useful for Schizophrenia?

Yes, the Mental Status Examination (MSE) is useful for schizophrenia. It assesses symptoms like delusions and hallucinations by focusing on thought content and perception components. Clinicians directly ask patients if they have experienced unusual beliefs or sensory experiences that others may not perceive, which indicate delusions or hallucinations. 

According to a study by Strub and Black titled The Mental Status Examination in Neurology, published by Neurology Press (2000), this approach enables the identification of common schizophrenia symptoms such as paranoid thoughts or auditory hallucinations, which are often hallmark features. 

By carefully evaluating these responses and observing the patient’s descriptions of their experiences, clinicians differentiate between psychotic symptoms and other cognitive or mood-related issues, leading to a more accurate diagnosis.

Can We Use MSE to Treat Anxiety Patients?

Yes, the Mental Status Examination (MSE) aids in the treatment of anxiety disorders by identifying specific symptoms like excessive worry, restlessness, and physical signs of tension. Clinicians use focused questioning and behavioral observations to evaluate anxiety levels, asking questions such as “Do you often feel nervous or on edge?” and “Have you experienced sudden feelings of panic or intense fear?” 

Observing motor activity, like fidgeting or tense posture, and speech patterns, such as rapid or hesitant speech, provides additional clues about anxiety severity. By detecting these signs early, clinicians tailor treatment plans to address both the psychological and physiological manifestations of anxiety, as emphasized by Strub and Black in The Mental Status Examination in Neurology (2000).

How can we use MSE for Different Types of Addiction?

The Mental Status Examination (MSE) is effectively used to assess different types of addiction, such as alcohol and opioid disorders, by identifying cognitive impairments, mood disturbances, and behavioral changes associated with substance use. 

According to a study by Joseph D. Reddon et al. titled Mental Status Examination as a Tool for Diagnosing Substance Use Disorders, published in Substance Use & Misuse (2022), the mental status examination effectively identifies substance use disorders with a diagnostic accuracy rate of 78%, demonstrating its significance in addiction assessment and management.

For alcohol use disorder, MSE findings reveal memory deficits, impaired judgment, and mood instability, which are often evident in cognition and insight components. Clinicians observe slurred speech or unsteady motor activity, indicating acute intoxication or withdrawal. 

In opioid use disorder, MSE detects mood symptoms like depression or anxiety alongside cognitive symptoms such as attention deficits and impaired decision-making. These findings are necessary for developing treatment strategies; for instance, cognitive-behavioral therapy (CBT) is implemented to address cognitive distortions, while medication-assisted treatments (MAT) like methadone or buprenorphine are specifically helpful in stabilizing opioid dependency symptoms.

The MSE provides a foundation for creating individualized treatment plans that address both the psychological and behavioral aspects of addiction.