People Presenting at Drug and Alcohol Services

Assessment for comorbid mental disorders and symptoms should form part of standard assessment procedures (see Chapter 4). 

It is essential that assessment of common problems such as anxiety and depression are routine practice in alcohol treatments settings.   

It is important to keep in mind that one purpose of assessment is to identify the issues that need attention. Particularly with complex and chronic problems, it is important to engage the person as they may have had multiple partially successful interactions with health services with the possibility of stigma and demoralisation. Assessment should also be focused on identifying the most pressing needs for the person including those that have the most immediate impact on their survival and quality of life. In this way, risk for suicide while intoxicated is a more immediate priority in assessment than differential diagnosis of major depressive disorder; risk for domestic violence more important than assessment of post-traumatic stress disorder; risk for tiredness and reduced motivation more important than assessing a sleep disorder; and impulsive risk taking more immediate than attention-deficit hyperactivity disorder. It is often necessary to begin treatment for potential comorbid concerns before a differential diagnosis can be established. Longer term care is benefited from broader awareness of the underlying conditions but collecting evidence for these should not interfere with engaging the person nor resolving immediate priorities. A period of abstinence (traditionally 4-6 weeks) is the most widely used way to make a differential diagnosis, recognising that abstinence may be difficult for some to achieve and treatment is often required before abstinence can be achieved.