The

instrument consists of 100 items that ask clients to identify their level of confidence in resisting drinking as a

response to the following eight types of situations (Marlatt and Gordon, 1985):

1. Unpleasant emotions

2. Physical discomfort

3. Testing personal control over substance use

4. Urges and temptations to drink

5. Pleasant times with others

6. Conflicts with others

7. Pleasant emotions

8. Social pressure to drink

The Alcohol Abstinence Self-Efficacy Scale (AASE) measures an individual's self-efficacy in abstaining from

alcohol (DiClemente et al., 1994). Although similar to the SCQ, the AASE focuses on clients' confidence in their

ability to abstain from drinking across a range of 20 different situations derived from the eight high-risk categories

listed above. The AASE consists of 20 items and can be used to assess both the temptation to drink and the

confidence to abstain

An instrument for assessing the importance of change has been developed (Sobell et al., 1996b), based on a

four-question scale originally used with smokers (Richmond et al., 1993). The questions were modified to inquire

about drinking, with responses in a specific range for each question. A composite motivation score is calculated

with a possible range from 0 to 10, based on the sum of the responses.

Would you like to reduce or quit drinking if you could do so easily? 1. (No = 0, Yes = 1)

How seriously would you like to reduce or quit drinking altogether? (Not at all seriously = 0, Not very

seriously = 1, Fairly seriously = 2, Very seriously = 3)

2.

Do you intend to reduce or quit drinking in the next 2 weeks? (Definitely no = 0, Probably no = 1,

Probably yes = 2, Definitely yes = 3)

3.

What is the possibility that 12 months from now you will not have a problem with alcohol? (Definitely not =

0, Probably not = 1, Probably will = 2, Definitely will = 3)

The Readiness Ruler, developed by Rollnick and used extensively in general medical settings, is a simple method

for determining clients' readiness to change by asking where they are on a scale of 1 to 10 

One significant feature of the readiness to change scale

is that clients assess their own readiness by marking the ruler or voicing a number. Another feature is that the

clinician can pose the question, "What would it take to move from a 3 to a 5?" or can recognize movement along

the continuum by asking, "Where have you come from last year to now?"

CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT

CIWA ETOH

1.2.1 Nausea and Vomiting

1.2.2 Tremor

1.2.3 Paroxysmal Sweats

1.2.4 Anxiety

1.2.5 Agitation

1.2.6 Tactile Disturbances

1.2.7 Auditory Disturbances

1.2.8 Visual Disturbances

1.2.9 Headache, Fullness in Head

1.2.10 Orientation and Clouding of Sensorium

More than 90 percent of alcohol

withdrawal seizures occur within 48

hours after the patient stops drinking.

Fewer than 3 percent of such seizures

may occur 5 to 20 days after the last

drink

Can result in 

 Thiamine B1 Depletion Wernicke Syndrome

 "wet brain"

 Korsakoff Syndrome

Mary Richmond 1917

1.)ASSESSMENT

2.)PLANNING

3.)LINKAGE

4.)MONITORING

5.)ADVOCACY 

Not currently considering change: "Ignorance is bliss"

Validate lack of readiness

Clarify: decision is theirs

Encourage re-evaluation of current behavior

Encourage self-exploration, not action

Explain and personalize the risk

Ambivalent about change: "Sitting on the fence"

Not considering change within the next month

Validate lack of readiness

Clarify: decision is theirs

Encourage evaluation of pros and cons of behavior change

Identify and promote new, positive outcome expectations

Some experience with change and are trying to change: "Testing the waters"

Planning to act within 1month

Identify and assist in problem solving re: obstacles

Help patient identify social support

Verify that patient has underlying skills for behavior change

Encourage small initial steps

Practicing new behavior for

3-6 months

Focus on restructuring cues and social support

Bolster self-efficacy for dealing with obstacles

Combat feelings of loss and reiterate long-term benefits

Continued commitment to sustaining new behavior

Post-6 months to 5 years

Plan for follow-up support

Reinforce internal rewards

Discuss coping with relapse

Resumption of old behaviors: "Fall from grace"

Evaluate trigger for relapse

Reassess motivation and barriers

Plan stronger coping strategies

Set a specific quit date, ideally within two weeks,

that has some meaning (e.g., anniversary, stress-free

weekend)

Tell family, friends, coworkers and others about

quitting, request extra support and understanding; ask

other smokers in the household to not smoke inside;

identify at least one non-smoker to talk to when

tempted to smoke

Anticipate challenges that will occur including

withdrawal symptoms, cravings, and high-risk

situations

Remove environmental triggers (e.g., ashtrays,

lighters); avoid smoking in ‘favorite’ places (e.g.,

car, dinner table, easy chair); limit smoking to

uncomfortable places (e.g., outside); recommend

visiting only smoke-free establishments

Men 2 drinks first hour, 1 drink per hour .8 or less

Women 1 drink per hour. 

Substance abuse

screening and

assessment tools,

in general, are

not as sensitive in

identifying women

as having substance

abuse problems.

Cluster A (odd or eccentric)

• 301.0 Paranoid personality disorder
• 301.20 Schizoid personality disorder
• 301.22 Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic)

• 301.7 Antisocial personality disorder
• 301.83 Borderline personality disorder
• 301.50 Histrionic personality disorder
• 301.81 Narcissistic personality disorder

Cluster C (anxious or fearful)

• 301.82 Avoidant personality disorder
• 301.6 Dependent personality disorder
• 301.4 Obsessive-compulsive personality disorder

NOS

• 301.9 Personality disorder not otherwise specified