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).