Download MRCPsych seminar series

Drug and alcohol assessment
MRCPsych addiction psychiatry seminar
series
Dr Stuart McLaren
2nd 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
– Analysing any ‘counter-transference’ that may
occur
Engagement
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Explain and provide confidentiality
Interview individually
Appropriate setting
Flexible approach
Be non-confrontational
Be non-judgemental
Be yourself
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
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 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
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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
Current:
Urine
Blood
Hair
Saliva
Under development:
Breath
Sweat
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.