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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 • • • • • • • 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 • • • • 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.