Psychiatric History and
Diagnostic assessment in specialized treatment
facilities, such as detoxification centers, residential programs, partial
hospital programs and outpatient clinics, should be conducted with a standard
interview schedule. If it is not possible to use a com-plete psychiatric
interview, such as the Composite International Diagnostic Interview (CIDI) or
the Structured Clinical Interview for DSM (SCID), then the alcohol sections of
these interviews should be used. Given the lack of reliability in unstructured
clini-cal diagnosis, it is imperative that programs specializing in the
treatment of alcohol dependence use a structured interview to conduct and
report their diagnostic evaluations.
An important purpose of clinical assessment is to
obtain an estimate of illness severity. The number of DSM symptoms obtained
using a structured interview can serve this purpose or the total score on the
AUDIT screening test.
Assessment of psychological function should focus
on measures of depression, anxiety and more global psychological distress.
Instruments that are generally reliable, valid and accept- able in a variety of
health care settings include the Beck Depres-sion Inventory and the Symptom
Checklist 90-Revised One sub-scale of the ASI assesses overall psychiatric
severity, including number of inpatient and outpatient treatment episodes,
medica-tion status, and lifetime and current symptomatology.
There has been considerable attention devoted to
the role of motivation and patient readiness to change, as critical
ingre-dients in treatment planning for alcoholics. The University of Rhode
Island Change Assessment Scale (URICA) is a 32-item questionnaire designed to
measure the stages of change across diverse problem behaviors. The URICA score
profiles have been used to predict treatment response in research on addictive
be-haviors such as smoking and alcoholism. The readiness to change
questionnaire (RCQ) (I is a short 12-item instrument developed for the same