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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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