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Drug and alcohol assessment

Drug and alcohol assessment. MRCPsych addiction psychiatry seminar series Dr Stuart McLaren 2 nd 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

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Drug and alcohol assessment

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  1. Drug and alcohol assessment MRCPsychaddiction psychiatry seminar series Dr Stuart McLaren 2nd March 2012

  2. 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

  3. Engagement • Explain and provide confidentiality • Interview individually • Appropriate setting • Flexible approach • Be non-confrontational • Be non-judgemental • Be yourself

  4. 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

  5. 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

  6. 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

  7. 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.

  8. Laboratory investigations of drug use Current: Under development: Urine Breath Blood Sweat Hair Saliva 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.

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