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Alcohol problems: Assessment and diagnosis https://www.porticonetwork.ca
CANADA'S MENTAL HEALTH & ADDICTION NETWORK
Alcohol problems quick reference:
Alcohol problems: Assessment and diagnosis
Overview Screening and referral
Key points The Alcohol Use Disorders Identification Test and the Alcohol Use Assessment Form can aid in assessment and diagnosis.
Assessment and diagnosis
Distinguish between at-risk drinking and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnoses of alcohol abuse and alcohol dependence. Consider the possibility of co-occurring mental health problems.
Treatment
Assessment tools Ongoing care
Alcohol Use Disorders Identification Test (AUDIT) The AUDIT helps to identify at-risk drinking and alcohol dependence. The 10-item survey can be given to clients to complete in the waiting room or in a faceto-face interview. The questionnaire asks how much the person drinks and whether he or she has experienced negative consequences of drinking. AUDIT helps to identify at-risk drinking and alcohol dependence. Download AUDIT questionnaire and manual [pdf].
Alcohol Use Assessment Form The Alcohol Use Assessment Form can be used to: take a history of alcohol use and collect other essential information, such as other drug use and drinking and driving record physical examination and laboratory measures The form includes a guide to diagnosing alcohol dependence versus at-risk drinking. Download the Alcohol Use Assessment Form [pdf].
Diagnosis Low-risk drinking guidelines (LRDG) The LRDG define low-risk drinking as: weekly intake of alcohol that does not exceed 15 standard drinks for males and 10 for females daily consumption that does not exceed two standard drinks for females and three standard drinks for males. Download Canada's Low-Risk Drinking Guidelines [pdf].
At-risk drinking People whose drinking exceeds the low-risk drinking guidelines do not usually meet the criteria for alcohol abuse or dependence listed in the DSM. However, their drinking puts them at higher risk of developing an alcohol-related medical, psychological or social problem. People who drink at an at-risk level are often not willing to accept a referral to a specialized addiction service. Moreover, the limited capacity of addiction services is often fully absorbed in helping clients with severe substance use disorders. Primary care providers have a responsibility to advise clients who drink at at-risk levels. Simple and brief counselling interventions are often effective.
Alcohol abuse: DSM-IV-TR criteria People may be diagnosed with alcohol abuse if they meet one or more of the following criteria in the last 12 months: recurrent use resulting in failure to fulfill major role obligations at work, school or home recurrent use in hazardous situations recurrent use-related legal problems use despite related social or interpersonal problems. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Copyright 2000 American Psychiatric Association.
Alcohol dependence: DSM-IV-TR criteria People may be diagnosed with alcohol dependence if they meet three or more of the following criteria in the last 12 months: tolerance, or a need for more alcohol to get the same effect withdrawal symptoms loss of control (i.e., drinking larger amounts or drinking for longer than planned) unsuccessful attempts to cut down salience, or significant time spent obtaining, using or recovering from the effects of alcohol reduced engagement in social, occupational or recreational activities because of alcohol use continued alcohol use despite knowledge of likely physical or psychological harm. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Copyright 2000 American Psychiatric Association.
Note: DSM-5 combines alcohol abuse and alcohol dependence into one diagnosis. Download a chart comparing at-risk drinking and alcohol abuse or alcohol dependence.
Co-occurring disorders Health Canada recommends that: all people seeking help from mental health services be screened for co-occurring substance use disorders all people seeking help from substance use services be screened for co-occurring mental health disorders.
Prevalence of co-occurring disorders Canadian population survey data shows that 28% of people identified with a current alcohol problem will also have a mental illness at some point in their lifetime. Moreover, rates of cooccurring disorders were two to three times higher among people in treatment. The highest rates of co-occurring disorders are found in institutions, including inpatient and outpatient mental health clinics, correctional facilities and addiction treatment programs.
Evidence summary American Psychiatric Association (DSM-IV-TR). (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author. Bondy, S., Rehm, J., Ashley, M., Walsh, G., Single, E. & Room, R. (1999). Low-risk drinking guidelines: The scientific evidence. Canadian Journal of Public Health, 90(4), 264–270. Butt, P., Beirness, D., Cesa, F., Gliksman, L., Paradis, C. & Stockwell, T. (2011). Alcohol and Health in Canada: A Summary of Evidence and Guidelines for Low-Risk Drinking . Ottawa, ON: Canadian Centre on Substance Abuse. Kahan, M. & Watts, K. (Eds.). (2010). Dealing with alcohol problems . In Primary Care Addiction Toolkit. Toronto, ON: Centre for Addiction and Mental Health. National Institute for Health and Clinical Excellence. (2011). Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (Clinical Guideline 115). London, UK: Author. Statistics Canada. (2002). Canadian Community Health Survey, Cycle 1.2. Ottawa: Author.
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I'd like to see more discussion of the differences between DSM IV and DSM 5 criteria. caro
Posted on 31/01/14 7:54 PM.