People Presenting to Mental Health Services

Alcohol use and the problems it can lead to are sufficiently common that the alcohol use of all people who come in contact with mental health services should be assessed.  The Alcohol Use Disorders Identification Test (AUDIT) (see Chapter 4) appears to be a suitable screening tool for identifying hazardous or harmful alcohol consumption and alcohol dependence among people presenting for mental health services.  

A non-judgemental attitude to alcohol use is a crucial for the assessment and management of alcohol use disorders in mental health services.  If AUDIT scores are in the hazardous or harmful range psychoeducation and practical advice to reduce drinking may be sufficient. If significant harms from drinking are revealed or the person has indications of dependence it is more likely that the alcohol problem  is unlikely to improve by focusing solely on their mental disorders and specific treatment is recommended.  As above differential diagnosis is possibly only useful for long term management and is unlikely to be the top clinical priority.  Alcohol use should not be dismissed as an acceptable way to cope with a mental disorder. The recommendations for the psychological and pharmacological management of alcohol use disorders throughout in this document should be implemented. There is mixed evidence for the use of brief interventions for alcohol use in those with other mental disorders. Thus, it may be reasonable to employ brief interventions for alcohol if there is adequate monitoring and follow-up so that intervention can be stepped up if treatment goals are not achieved. 

Alcohol use is associated with increased risk for suicide. Intoxication is likely to increase the changeability of suicide risk and present an increased acute risk. Withdrawal and early abstinence may also be a period of increased risk as distress and symptoms that may indicate a mental disorder may increase. People with comorbid mood and alcohol use disorder should be regularly assessed and monitored for risk of suicide according to established guidelines (see Appendix 5). 

Chapter Recommendation Grade of recommendation
21.9 AUDIT in full or briefer versions (AUDIT-C) is recommended to help identify AUD in those attending mental health services as part of a comprehensive assessment. A
21.10 Brief intervention including motivational interviewing is recommended for people with mental disorders and hazardous or harmful alcohol use who are presenting for mental health care with adequate monitoring and follow-up to step up intervention if reduced drinking is not achieved. D