Assessing Mental Health Disorders

Psychological problems and psychiatric comorbidity – most commonly depression and anxiety – are more prevalent among alcohol-dependent people than the general population. It is essential to discover if psychiatric comorbidity and/or psychological problems are present in alcohol-dependent patients. Such problems can include: 

• • • anxiety, depression, post-traumatic stress disorder, psychosis 

    • suicidal ideations and past history of suicide attempts 

    • childhood issues, including sexual and physical abuse. 

The presence of psychological problems requires mental-state examination by suitably trained clinicians and clinical assessment of mental symptoms. A targeted risk assessment of the possibility of harm to self and/or others, including children, should be performed. It is important that all clinicians in this area develop basic mental health skills and links with other relevant services to help manage these disorders. 

Patients need to be reassessed at regular intervals, for example after 3 or 4 weeks of treatment to reduce alcohol consumption, and a final psychiatric diagnosis will be delayed until this time. It is likely that many mental symptoms are reactions to the chaos and disarray in the patient’s life that are associated with the drinking problem, or to the neurological effects of alcohol. Some of these symptoms resolve, without formal therapy, when the drinking ceases or decreases. The drinking problem may also be causing the anxiety, rather than the reverse, but serious anxiety disorders may be present and may precipitate relapse. 

A high percentage of alcohol-dependent women in treatment have had some experience of physical and/or sexual abuse. Questions about sexual abuse should be framed in a non- threatening way so the patient can choose whether to discuss the issue. Women with a history of child sexual abuse who are pressured to discuss the issue with non-specialist counsellors may endure negative treatment outcomes. Based on these trends, and drawing on clinical expertise, it has been argued that if child sexual abuse is an issue, the patient should be offered referral for specialist intervention. Many patients will not wish to pursue the issue. 

Although caution should be exercised in addressing child sexual abuse, clinicians need to discuss it without seeming tentative or fearful. In some jurisdictions, training in dealing with child sexual abuse is now available for alcohol and drug counsellors. A number of jurisdictions have established services for treating victims of child sexual abuse but resources are limited. 

A variety of scales are used in clinical and research settings for assessing mental health conditions (see Table 4.2). They are variously used according to clinician preference, treatment setting and patient population. For example, the Kessler 10 Symptom Scale is reasonably widely used in the public sector. In general, these instruments have not been validated in alcohol-dependent populations. 

Note: * all in the public domain, the others need to be purchased.