Comprehensive Clinical Assessment

Many persons with unhealthy alcohol use identified through an early detection (screening) approach will respond to a brief intervention. Where it is apparent that the individual has significant alcohol-related harm or does not respond to brief intervention, comprehensive clinical assessment is indicated to guide the practitioner to further management. Further assessment is therefore indicated for those who have: 

• • • not responded to advice to reduce their consumption of alcohol 

    • more substantial alcohol-related problems 

    • asked for or need help to deal with their drinking

Assessment should include diagnostic interviews, physical examination, investigation of clinical and biological markers, and gathering of collateral information about the patient. Assessment intensity and detail varies across settings; the amount of assessment relates to the level of specialisation in alcohol problems. The areas for assessment include: 

• • • alcohol consumption pattern 

    • severity of dependence 

    • alcohol-related harms (such as physical and psychological health problems, relationship problems, occupational problems and legal problems) 

    • motivation to change 

    • family factors 

    • cognitive functioning. 

The need for comprehensive assessment must be balanced with the desire to engage and retain the patient in treatment. If the patient perceives that little or no progress is being made in the first sessions, their motivation to stay in treatment may wane. The assessment might be spread over several sessions, allowing some time in each session for setting preliminary treatment goals and working toward those goals. As more in-depth assessment occurs, these treatment goals and strategies may need adjustment. Assessment continues throughout treatment as the patient’s progress is measured against the treatment goals. 

From the first contact with the patient it is important to instil a sense of hope and a belief that change is possible. This is especially important in patients who have repeatedly tried to alter their drinking habits and failed. Self-efficacy (that is, the patient’s belief that there is something they can do about their problem) is an important factor in treatment success. Self-efficacy may, in turn, be influenced by the therapeutic relationship (see Chapter 6).