Drug and alcohol assessment

MRCPsych addiction psychiatry seminar series

Dr Stuart McLaren2nd March 2012

Engagement – the first step

What is engagement?• Building a working relationship– Showing that you care– Working towards mutually acceptible goals– Building rapport– Building trust– Analysing any ‘counter-transference’ that may

occur

Engagement

• Explain and provide confidentiality• Interview individually• Appropriate setting• Flexible approach• Be non-confrontational• Be non-judgemental• Be yourself

Overview of assessment

Aim of assessment is:• To obtain a drug and alcohol history• Perform MSE and physical examination• Establish a SUD• Estimate patient’s readiness to change

History taking

Tailor to circumstances:– Comprehensive assessment is not always

necessary or helpful on first encounter– Can be done over several sessions– What do I need to know in this case at this time?

All patients should have:– Quantified alcohol history– Quantified smoking history

History taking

• Maintain a high index of suspicion for other substances:– Ask more detailed questions where indicated

• Where a positive history exists:– Obtain a comprehensive drug and alcohol history– Assess whether daily intake is increasing or

decreasing

Recommended testing for alcohol use disorders

• Liver function tests (incl. ALT, AST and GGT)• Full blood count (incl. MCV)• Serum B-12 and folate (or red cell folate)• Breath alcohol test

Use of investigations in the diagnosis and management of alcohol usedisorders (1999) by Drummond C & Ghodse H, Advances in Psychiatric

Treatment, 5, 366-375.

Laboratory investigations of drug use

Current: Under development: Urine Breath Blood Sweat Hair Saliva

Specific laboratory investigations for assessment and management of drugof drug problems (1999) by Wolff K et al., Advances in Psychiatric Treatment,

5, 180-191.