Assessing people with alcohol problems
Assessment of risk
An assessment of immediate risk needs to be made. You should look for indications of increasing chaotic behaviour (including recent increases in drinking) and for any indications that an immediate medical/mental health assessment/intervention is required. Find out whether a medical assessment has been carried out recently by a GP or CAT team and if so obtain permission to make contact with them. If not, do any of the following apply?
- Previous psychiatric admissions, history of depression or suicide attempts
- Recent admissions to general hospital or any injuries or accidents (including self-harm or recent suicide attempts)
- Recent episodes of ill health
- Is the person saying they need detoxification?
- If they are not asking for detoxification does the amount they are drinking or their general condition suggest medical assessment is required?
If in any doubt about the person's physical or mental condition a second opinion should be sought immediately from an appropriate professional. Alcohol problems frequently mask mental health problems. Both mental illness and alcohol problems carry a powerful social stigma, a potential risk of violence or self-harm and a high relapse rate. Alcohol plays a role in anxiety, depression and schizophrenia as well as suicide and attempted suicide. Mental health assessments should not be refused on the grounds that the person is drinking or has a drink problem.
Other factors, which suggest that a person’s drinking is getting, or has become, out of control, are:
- Aggressive incidents.
- Loss of accommodation.
- Recent arrests or conviction.
- Evidence of recent breakdown in home situation or relationships.
- Recent loss of employment.
These all denote immediate intervention would be beneficial whether or not medical intervention is called for.
Given that people with alcohol problems are reluctant to come forward for help, those who do, particularly those presenting for the first time, or the first time after a period of stability, should be dealt with urgently whilst they are aware of the need to tackle their alcohol problem.
Information needs to be gathered covering all these areas:
- Legal situation.
- Physical and mental health.
- Financial situation.
- Family situation.
- Details of client’s choice and expectation of treatment.
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