DAWN BEAZER CAAP 6613 ASSESSMENT: PROCESSES & APPLICATIONS UNIVERSITY OF LETHBRIDGE

ALCOHOL ABUSE

What will be covered...

General Info. and Stats. on Alcohol Use and Abuse Screening Tools Diagnosis Drinking Practice Measures Denial Informal Assessment

Alcohol Use

Alcohol is the most frequently used depressant in most cultures. Alcohol is a major cause of morbidity and mortality. 90% of people have had some experience with alcohol. 60% of males and 30% of females have had an adverse life event due to alcohol. (Drinking and driving, missing work or school because of hangover) Most individuals learn from this and change their behavior. Those that do not, can face Alcohol Dependence or Abuse.

Alcohol Use Continued...

Most prevalent mental disorder Alcohol misuse is more common than all other drugs combined Genetic component Age and Gender Ethnicity

What age range has the most substance abuse?

Drinking Patterns
What is the size for a standard drink?

Moderate Drinking At-Risk Drinking Alcohol Abuse Alcohol Dependence

Nature and Goals of Assessment

Varies depending upon...

Severity of Problem Setting Population Characteristics Available Resources Purpose of Assessment

Screening
Brief assessments intended to identify persons at-risk without detail of treatment planning Particularly in nonspecialty medical settings (clinics, ER, trauma centers) Important for medical management and preventing future health problems Detect and refer Include verbal report and biological tests

Verbal Report
Screening Measures AUDIT MAST CAGE TWEAK

Some terms to know...

Tolerance Withdrawal

AUDIT (Alcohol Use Disorders Identification Test)

10 Items Pen & Pencil Based on cross-cultural analysis of 6 countries Catch the need for early intervention Addresses severity Strong psychometrics

MAST (Michigan Alcohol Screening Test)

25 Items, yes/no Oral or written Pencil & paper or Computerized version No concrete description of development

CAGE

Have you ever tried to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to settle your nerves or to get rid of a hangover? (Eye-opener)

TWEAK

T W E A K

Tolerance Friends or relatives worried about your drinking Eye-opener Amnesia Ever attempted to (K) cut down on drinking

Biological Tests
Breathalyser Blood Tests Not a stand alone

Next Steps
Mild or Moderate Problem

Serious Problems

Brief motivational intervention during screening Follow-up sessions or phone calls.

Referral for assessment for treatment. Diagnostic evaluation including substance use measures, dependence, negative psychosocial consequences and comorbid psychopathology.

Diagnosis Structured Interview

DSM PRISM (Psychiatric Research Interview for Substance and Mental Disorders) AUDASIS (Alcohol Use Disorders and Associated Disabilities Interview Schedule) CDP (Comprehensive Drinker Profile)

DSM-IV-TR
Substance-Related Disorders Substance Dependence Substance Abuse Alcohol-Related Disorders

DSM Criteria
Alcohol Dependence

Alcohol Abuse

Tolerance Withdrawal

Requires fewer symptoms than dependence and only diagnosed in absence of dependence

Alcohol-Induced Disorders

Alcohol Intoxication Alcohol Withdrawal Alcohol Intoxication Delirium Alcohol Withdrawal Delirium Alcohol-Induced Persisting Dementia Alcohol-Induced Persisting Amenestic Disorder Alcohol-Induced Psychotic Disorder, With Delusions

Alcohol-Induced Psychotic Disorder, With Hallucinations Alcohol-Induced Mood Disorder Alcohol-Induced Anxiety Disorder Alcohol-Induced Sexual Dysfunction Alcohol-Induced Sleep Disorder Alcohol-Related Disorder Not Otherwise Specified

Drinking Practices Measures

Retrospective Interviews Timeline Followback Form-90 Lifetime Drinking History Self-monitoring

Promoting Accurate Reporting

DENIAL

The absence of negative consequences for reporting substance use or problems Assuring confidentiality Collateral information from sober individuals Using measures of observable events and behaviors rather than subjective and mental averaging Use of recall aids such as calendars when measuring retrospectively

Overview
What does the process look like with a typical client?

Personal Reflection
Diagnosis Informal Assessment

Questions

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Antony, M.M., & Barlow, D.H. (2010). Handbook of assessment and treatment planning for psychological disorders (2nd Ed.). New York, NY: The Guilford Press. Ash, P. (2010). Alcohol use disorders identification test (Review of the Alcohol Use Disorders Identification Test, by World Health Organization). Retrieved from http://0web.ebscohost.com.darius.uleth.ca/ehost/search/advanced?sid=dab8fa0c1b4d-461e-85fb-3fb4678d3cdb%40sessionmgr110&vid=7&hid=110 Conoley, J. & Reese, J. (2010). Michigan Alcoholism Screening Test. (Review of the Michigan Alcoholism Screening Test, by Selzer, M.) Retrieved from http://0web.ebscohost.com.darius.uleth.ca/ehost/search/advanced?sid=dab8fa0c1b4d-461e-85fb-3fb4678d3cdb%40sessionmgr110&vid=7&hid=110 Culberson, J. (2006). Alcohol use in the elderly: Beyond the CAGE: Screening instruments and treatment strategies. Geriatrics, 61(11), 20-27.