Assessment

Abstract

This chapter provides an outline of clinical and ethical considerations in the assessment of alcohol use across the lifespan. While harmful alcohol use is a public health problem in all age groups in all countries, given concerns regarding the problems and vulnerabilities associated with underage drinking and heavy alcohol consumption during adolescence and young adulthood (see chapter “Child, Adolescent and Young Adult”), particular attention is paid to assessment of alcohol use in these age groups. While much of the content in the chapter is derived from the authors’ own country, Australia, the material covered will be of interest to readers from other countries. The quality of the working relationship or alliance a heath professional forms with the person with whom they are working is fundamental to safe and effective clinical work, including assessment. Therapeutic presence is an important aspect of this working alliance and is thus addressed in some detail in the chapter. The assessment of alcohol use involves both technical-procedural and moral-ethical considerations and both are addressed in the chapter. The questions being asked and how they are asked in an assessment are important. Poor questioning technique can result in important omissions in the information being sought, adversely affecting problem formulation and treatment decision-making. However, failure to acknowledge and deal with the strong disapproval that often surrounds harmful drinking can result in a person being exposed to stigma and injustice in and beyond the healthcare system; this can further compound already complex and serious problems. The chapter considers protective empowerment as an ethical framework that can be applied when health professionals face having to balance safety concerns against individuals’ lifestyle choices, in the assessment and treatment of alcohol use problems. The chapter includes case studies and reflective activities.