Chapter 3 Screening, assessment and treatment planning - Alcohol

Gathering collateral informationExcessive alcohol use and its consequences are stigmatised problems that manypatients are reluctant to acknowledge. Collateral interviews play a central role wherethe patient does not self-report their use of alcohol or its consequences. Collateralinformation is particularly needed where a discrepancy appears likely.There are significant barriers that limit access to collateral reports, including legal(privacy legislation limits the distribution of personal information without consent),ethical and financial (the enquiry can be time consuming). Patients may object tosuch enquiries and the therapeutic relationship may be disrupted.Recommendation3.17 Collateral reports should be incorporated inthe assessment where inconsistencies appearlikely, with the patient’s permission wherepossible, and subject to legal and ethicalboundaries.Strength ofrecommendationSLevel ofevidenceFamily factorsPatients should be encouraged to explore relevant family issues during assessmentincluding the relationships with their spouse or partner, their parents, their children,and other significant people in their lives including any attributions about the effectsof the patient’s drinking.Domestic violence and sexual abuse, either as perpetrator and/or victim, arecommon and serious problems associated with alcohol and other substance use.Because of the sensitivity of these issues, it may not be appropriate to raise them inthe first contact session unless there is reason to believe there may be a currentsafety risk. It is important to determine whether the patient wishes to discuss theseissues. Specialist assessment and intervention is typically required.When it is possible the clinician should interview the spouse or the family members.The family interview is an opportunity for family members to ask questions and tovoice their concerns. It may also help the family see the drinking problem inperspective.While this kind of complex information is best obtained by clinical interview, AlcoholProblems Questionnaire has a subscale assessing family problems and oneassessing marital/relationship problems (see Appendix) (Drummond 1990).Recommendation3.18 The social support for the patient should beassessed and this information should beincorporated into the management plan.3.19 Clinicians should determine if the patientcares for any children under the age of 16, andact according to jurisdictional guidelines if thereare any concerns about child welfare.Strength ofrecommendationSSLevel ofevidence36