What questions should be asked in an initial psych eval for alcohol abuse?

Essential Questions for Initial Psychiatric Evaluation of Alcohol Abuse

The most effective initial psychiatric evaluation for alcohol abuse should include standardized screening tools like the AUDIT or CAGE questionnaire, followed by a comprehensive assessment of drinking patterns, consequences, and DSM-5 criteria for Alcohol Use Disorder. 1

Validated Screening Tools

• AUDIT (Alcohol Use Disorders Identification Test) - A 10-question assessment that evaluates alcohol consumption patterns, drinking behaviors, and alcohol-related problems with high sensitivity and specificity for detecting hazardous drinking and alcohol use disorders 1, 2
• AUDIT-C - A shortened 3-question version focusing only on consumption patterns that maintains good sensitivity while requiring less time to administer 3
• AUDIT-3 - For very time-limited settings, using just the third AUDIT question about binge drinking can serve as an initial screen 1
• CAGE Questionnaire - A brief 4-question tool with 85% sensitivity and 89% specificity that asks about attempts to Cut down, Annoyance with criticism about drinking, Guilt about drinking, and using alcohol as an Eye-opener 1, 4

Comprehensive Drinking Pattern Assessment

• Quantity and frequency questions: "How often do you drink?" and "How many drinks do you typically consume on days when you drink?" 1
• Pattern of consumption: "How often do you have 5 or more drinks (for men) or 4 or more drinks (for women) on one occasion?" 1
• Maximum consumption: "What is the maximum number of drinks you've had on any single occasion in the past month?" 5
• Drinking context: "In what settings do you typically drink?" and "Do you drink alone or with others?" 1

Assessment of DSM-5 Criteria for Alcohol Use Disorder

• Loss of control: "Have you often found that when you start drinking you end up drinking more than you intended?" 1
• Unsuccessful attempts to cut down: "Have you tried to cut down or stop drinking, or promised yourself you would, but couldn't keep your promise?" 1
• Time spent: "How much time do you spend drinking or recovering from drinking?" 1
• Cravings: "Have you experienced strong urges or cravings to drink?" 1
• Role failure: "Has your drinking interfered with your responsibilities at work, school, or home?" 1
• Social/interpersonal problems: "Has your drinking caused problems in your relationships?" 1
• Activities given up: "Have you given up or reduced important activities because of your drinking?" 1
• Hazardous use: "Have you driven a car or operated machinery after drinking?" 1
• Physical/psychological problems: "Have you continued to drink despite physical or mental health problems that might be caused or worsened by alcohol?" 1
• Tolerance: "Do you need to drink more than you used to in order to get the same effect?" 1
• Withdrawal: "Do you experience shaking, sweating, nausea, anxiety, or other symptoms when you stop drinking?" 1

Assessment of Consequences and Impact

• Medical consequences: "Have you experienced any health problems related to your drinking?" 1, 6
• Social consequences: "Has your drinking affected your relationships with family, friends, or colleagues?" 1
• Occupational consequences: "Has your drinking affected your work performance or led to absences?" 1
• Legal consequences: "Have you had any legal problems related to your drinking, such as DUIs?" 6
• Financial consequences: "Has your drinking caused financial difficulties?" 1

Risk Assessment

• Suicide risk: "Have you had thoughts of harming yourself, especially when drinking?" 6
• Violence risk: "Have you become aggressive or violent when drinking?" 1
• Withdrawal risk: "Have you experienced severe symptoms when stopping drinking, such as seizures or hallucinations?" 1

Treatment History and Readiness

• Previous treatment: "Have you ever sought help for your drinking before? What worked or didn't work?" 6
• Motivation for change: "On a scale of 1-10, how important is it for you to change your drinking habits?" 6
• Barriers to treatment: "What concerns do you have about changing your drinking habits?" 5

Common Pitfalls to Avoid

• Relying solely on laboratory tests (MCV, liver enzymes) for screening, as these have poor sensitivity 4
• Failing to use standardized screening tools, which significantly improves detection rates 4, 5
• Not addressing identified alcohol problems - studies show that even when physicians detect alcohol problems, they often fail to intervene 5
• Using confrontational approaches that may increase patient resistance 6
• Focusing exclusively on alcohol consumption without assessing functional impairment and consequences 1