Psychiatric History and Examination
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 purpose.