Assessing people with alcohol problems

A broad framework for assessing the appropriate level of intervention

Many clients presenting to health and welfare services may not readily attribute their drinking behaviour to the problems they experience. Nevertheless, staff will wish to establish whether alcohol is a significant factor in making a proper assessment of their clients. Whether or not a client is asking for help in relation to alcohol, the following guide may be useful in assessing the level of alcohol intervention that is required.

No alcohol problem indicated	Those who drink less than the recommended levels (3-4 units a day for men and 2-3 units a day for women), and do not regularly become intoxicated, and whose presenting problems have no association with alcohol misuse.
No alcohol problem indicated but at risk of damage to health	Those who either regularly drink significantly more than the recommended levels, or who become intoxicated sometimes, but not frequently, but whose presenting problem has no strong association with alcohol misuse. For example someone with problems relating to employment, housing or family relationship who does drink and occasionally becomes drunk but whose problems are not associated with their drinking pattern. In such cases, general advice about the health effects of alcohol and sensible drinking advice (brief intervention) would be recommended.
Alcohol problem indicated	Those who regularly drink significantly more than the recommended levels and up to 50 units per week for men and 35 units per week for women, and those who become regularly intoxicated, with this contributing to the presenting problem (family troubles, loss of work and financial difficulties, problems in taking action to alleviate other difficulties) do have an alcohol problem requiring intervention. This needs to aim, at least, towards reducing consumption and controlled drinking, as well as consideration of the underlying reasons for misusing alcohol. Referral to an alcohol advice and counselling service should be considered.
Serious alcohol problem indicated	Those who regularly drink at or above the dangerous levels (50 units per week for men and 35 units per week for women), or whose health is affected by their alcohol consumption, or who are alcohol dependent irrespective of the nature of the presenting problem. This group can be expected to have a serious alcohol problem and may require detoxification. They will require specialist help and detoxification may be needed prior to referral to a day programme or residential rehabilitation centre.