Assessment of Alcohol Use
Disorders
Comprehensive assessment provides the basis for an
individual-ized plan of treatment. Depending upon the severity of alcohol
dependence, the nature of comorbid medical and psychiatric pa-thology, the
presence of social supports, and evidence of previ-ous response to treatment,
decisions can be made concerning the most appropriate intensity, setting and
modality of treatment.
Although
denial of alcohol-related problems is legendary among alcoholics, there is
substantial evidence that a valid alco-hol history can be obtained, given
adequate assessment proce-dures and the right conditions. A complete alcohol
history should include specific questions concerning average alcohol
consump-tion, maximal consumption per drinking occasion, frequency of heavy
drinking occasions and drinking-related social problems (e.g., objections
raised by family members, friends, or people at work), legal problems
(including arrests or near-arrests for driving while intoxicated [DWI]),
psychiatric symptoms (e.g., precipita-tion or exacerbation of mood or anxiety
symptoms), and alcohol-related medical problems (e.g., alcoholic gastritis or
pancreatitis).
It is crucial that questions concerning alcohol
consump-tion and related problems be asked nonjudgmentally in order to enhance
the likelihood of accurate reporting. The optimal ap-proach to history-taking
in the substance abuse patient includes reassuring the patient that information
provided will be kept confidential. The interview begins with questions that
are least likely to make the patient defensive (e.g., a review of systems or
psychiatric symptoms, without relating these to alcohol use), and beginning
questions with How, rather than with
Why, to reduce the appearance of
being judgmental (Schottenfeld, 1994).
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