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Diagnostic Interviews

The initial assessment should ideally take the form of an open-ended, semi-structured interview where the patient and the clinician compile a narrative history, using appropriate questionnaires if desired (see Table 4.1). This has the advantage of clinician involvement that is personal and responsive to the person who drinks, rather than mechanical and impersonal. Yet, it should maintain a purposeful structure so as to avoid a vague, directionless discussion of their history or rumination on a few aspects. Standardised questionnaires are not often used at this stage, but in selected cases a number of validated instruments may prove useful. 

TABLE 4.1: Matters to be covered in a comprehensive assessment

Presentation
  • Presenting problems
  • Role of drinking/drug use in presenting problems
  • Motivation for presentation
  • Other concerns
Medical and
psychiatric
comorbidity
  • Physical health problems (including liver, gastro-intestinal, trauma cardiovascular, neurological, cognitive, endocrine)
  • Mental health problems (depression, anxiety, psychosis, suicide risk)
Social
circumstances
  • Social functioning (including relationship, employment, financial housing, legal)

Examination

(by suitably
trained health
professionals)
  • Physical examination (general examination, signs of intoxication or withdrawal, nutritional assessment, neurological function, gastrointestinal, cardiovascular)
  • Mental state examination (signs of intoxication or withdrawal, cognitive function, mood, motivation and insight)

Note: Comprehensive assessment may require more than one consultation, and involve gathering of additional information from clinical investigations and collateral history.

A complete assessment should evolve over two or more sessions as an ongoing part of the treatment. It should not be viewed as something that must be completed at the first visit and not revisited. Specific areas that need assessment include: 

    • level and history of alcohol consumption

    • dependence 

    • alcohol-related harms, including  

        • physical status 

        • psychological and psychiatric status 

    • cognitive functioning

    • motivation 

While each area needs to be covered to ensure a comprehensive assessment, not every patient will need to be assessed extensively on each. In some cases, such a detailed assessment is unnecessary, as the status of the patient will be obvious. In other cases the information provided will allow the clinician to carry out a careful assessment of the important aspects. 

The structure of clinical assessments differs between medical, psychological, nursing and other health professionals for a range of reasons and may also need to be adapted to suit the environment in which it is being conducted. Structured diagnostic interviews are available but, due to their length, are often too cumbersome for clinical practice; their use is generally limited to research and forensic settings and in training (see also Review of the Evidence).

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