How many times in the last year have you had more than six drinks?
Has drinking alcohol ever caused problems for you?
Have you ever been admitted to hospital because of an accident? How often?
Has any close relative had alcohol problems?
Would you get along better with a spouse/partner or close friends if you drank less?
Expand these questions to get a more complete picture of alcohol and other drug
use, using specific questions to determine alcohol use and pattern of drinking more
accurately.
Check that you have covered the following areas:
frequency of drinking/drug taking
quantity consumed
pattern of consumption (i.e. binge, continuous)
situational triggersduration of hazardous or harmful drinking/drug taking
previous attempts to stop or cut down
adverse consequences of substance use on family, work, social relationships, and
health
loss of control when using primary substance
the patient’s perception of his or her substance use, both the need and perceived
ability to change behaviour, e.g. ‘do you think your alcohol use is a problem?’
Additional areas to cover
Substance career - when use started, pattern over time, when problems/withdrawal
symptoms developed
Substance consumption - how much in the last year, 6 months, week - What changes
over this period?
Substance related problems - ever, recently
Other substance use - type, quantity, method of consumption, problems
Abstinent periods - reason, duration, perceived support, outcome
Previous treatment history - type of treatment, when previous treatment undertaken
, method of treatment
Forensic history - charges, convictions, imprisonment
Occupational history - relationship of substance(s) use to job
Further assessment as appropriate:
Personal history - developmental milestones, school, work, sexual, marital
history and relationship to alcohol use
Family history - parents’ and siblings’ age, relationship with patient, family
history of substance use
Sexual history - STD risk behaviour, needle sharing, unprotected sex, risk
of pregnancy, effect of alcohol on these risks
Marital history - general problems, sexual functioning problems, effect of
drinking on these problems
Present life situation - family/social supports, friends, job prospects It
is important to ascertain the risk of harm to self or others (including suicide
and suicide ideation, and risk with driving)
Specific assessment issues - ask these as appropriate:
Physical and sexual abuse
Some helpful questions:
Do you feel safe in your current relationship?
Have you always been safe in relationships?
Have you ever been abused in a relationship - physically or sexually?
Comorbidity
These two questions have been found to effective screening for depression:
Over the past two weeks, have you ever felt down, depressed or hopeless?
Have you felt little interest or pleasure in doing things?
Positive responses indicate a need for further assessment.
Diagnosis of alcohol use disorders
Risk assessment:
Risk will vary depending on weekly consumption, episodes of heavy drinking and susceptibility
to alcohol effects (based on age, sex, pregnancy, family history, medical and psychological
problems, use of medication, nature of job).
Risk level
Men
Women
(standard drinks per week)
Low
under 21
under 15
Intermediate
21 - 50
15 - 35
High
over 50
over 50
DSM IV alcohol use classification
Alcohol use can be formally classified according to DSM IV criteria into a major
category of alcohol dependence (mild, moderate or severe) and a residual
category of alcohol abuse.
Alcohol Dependence:
The key features of the alcohol dependence syndrome are:
A maladaptive pattern of alcohol use leading to clinically significant impairment
or distress, as manifested by three (or more) of the following, occurring at any
time in the same 12 month period:
tolerance, as defined by either:
a need for markedly increased amounts of alcohol to achieve intoxication or the
desired effect
continued use of the same amount of alcohol with markedly diminished effect
withdrawal, as manifested by two or more of the following occurring after
cessation or reduction of heavy prolonged alcohol use:
autonomic hyperactivity such as sweating or heart rate in excess of 100 beats per
minute
hand tremor
nausea or vomiting
transient visual auditory or tactile hallucinations
psychomotor agitation
anxiety
grand mal seizures
alcohol is consumed in larger amounts or over a longer period than was intended
there is a persistent desire or unsuccessful efforts made to cut down or control
alcohol use
a great deal of time is spent in activities necessary to obtain alcohol, consume
it, or recover from its effects
important social, occupational or recreational activities are given up or
reduced because of alcohol use
alcohol use is continued despite a physical or psychological problem that
is likely to have been caused or exacerbated by the substance.
Alcohol Abuse:
The essential features of the abuse syndrome are:
A maladaptive pattern of alcohol use causing clinically significant distress
or impairment of social or occupational functioning.
Maladaptive use will include high daily consumption, regular heavy weekend drinking,
binge drinking (staying drunk for days, often after periods of abstinence).
One or more of the following must have occurred as a result of recurrent alcohol
use within a 12 month period:
failure to fulfil major role obligations e.g. r e.g. repeated absences or
poor work performance related to alcohol use; suspensions, or expulsions from school;
neglect of the children or household
exposure to physical hazards e.g. driving an automobile or operating a machine
when impaired by alcohol use.
legal problems e.g. arrests for alcohol-related disorderly conduct.
social or interpersonal problems e.g. arguments with partner about consequences
of intoxication, physical fights whilst drunk.
A diagnosis of an abuse syndrome is not made if the person is dependent on alcohol.