Assessing people with alcohol problems

   Introduction

This section outlines the areas that need to be covered in assessing people with drinking problems. It will be of interest to social workers, mental health workers and probation officers and nurses. A broad framework is offered as an introductory guide to considering the level of specialist alcohol treatment that may be appropriate.

When dealing with individual clients, generic professionals are advised to seek further advice. Help may be available from the local alcohol service and further information on relevant publications can be obtained from Alcohol Concern’s Library database www.alcoholconcern.org.uk. Risk assessment is a special area of concern given recent increases in the level of reported dual diagnosis (co-occurring mental health and alcohol/drug problems) and concern about at-risk groups who have difficulties in maintaining engagement with services.

Social services have a responsibility to assess people needing help with alcohol problems. Many social services departments have special alcohol (and drug) care managers and multi-disciplinary assessment is often required for detoxification or for cases of dual diagnosis. Some social services departments have contracted out the assessment function to independent alcohol agencies. Many clients presenting to social services for assessment do so because of the need for funding from the local authority for a rehabilitation programme. Although a broader approach should be taken to encourage earlier intervention and access to a wider range of treatment alternatives, this is not often in evidence.

Probation services increasingly purchase some of the services needed by their clients. Probation officers are involved with people misusing alcohol in a number of ways. These include when offenders with alcohol problems are bailed (particularly if they are homeless), when pre-sentence reports are being prepared for offenders with alcohol problems, when supervision orders are being implemented (especially when the order includes requirements which are designed to address the offender’s alcohol problem) and when prisoners with alcohol problems are being prepared for, and supported after, release. In order to select the most appropriate intervention, probation officers will need to undertake assessment and make judgements about appropriate intervention.

Mental health professionals report an increasing number of referrals from people with alcohol problems. Assessment to diagnose underlying mental health problems is required and many mental health workers feel they lack skills in this area. The need for multi-disciplinary skills and joint working is paramount for people who may have a co-occurring mental health and substance misuse problems, as they are likely to represent a higher risk (to themselves and others).

Individual assessors may not have had training on alcohol problems and may have limited knowledge of the services available; they can find it difficult to make informed decisions about the most appropriate package of care for their clients.

To advice for affected others section