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Drug and alcohol assessment. MRCPsych addiction psychiatry seminar series Dr Stuart McLaren 2 nd 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

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drug and alcohol assessment

Drug and alcohol assessment

MRCPsychaddiction psychiatry seminar series

Dr Stuart McLaren

2nd March 2012

engagement the first step
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
Engagement
  • Explain and provide confidentiality
  • Interview individually
  • Appropriate setting
  • Flexible approach
  • Be non-confrontational
  • Be non-judgemental
  • Be yourself
overview of assessment
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
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 taking1
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
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 use

disorders (1999) by Drummond C & Ghodse H, Advances in Psychiatric Treatment, 5, 366-375.

laboratory investigations of drug use
Laboratory investigations of drug use

Current: Under development:

Urine Breath

Blood Sweat

Hair

Saliva

Specific laboratory investigations for assessment and management of drug

of drug problems (1999) by Wolff K et al., Advances in Psychiatric Treatment,

5, 180-191.

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