CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Module Content Objectives Introduction General Screening For Domestic Violence and Sexual Assault -- Domestic Violence Screening Statements -- Additional Statements of Support Addressing Alcohol Abuse With Domestic Violence Clients -- Screening Instruments for Alcohol Use -- Assessments For Alcohol Use -- Talking About Alcohol Abuse -- Supporting Sobriety Assessing Violence for Women in Alcohol Treatment -- Domestic Violence Screening -- Domestic Violence Assessment Tips Addressing Alcohol Abuse With Men in Treatment For Violence -- Alcohol Screening -- Alcohol Assessment Addressing Domestic Violence With Men in Alcohol Treatment -- Abuse Screening -- Timing for Batterer Intervention/Relapse Prevention Child Maltreatment and Abuse Psychiatric Comorbidities -- Dual Diagnosis Safety Planning Summary of Module References Module 7 Quiz

Assessments For Alcohol Use

Informed clinical judgment is essential for a sound assessment, but validated substance abuse assessment instruments also can provide a useful structured approach for many clinicians. They provide a convenient checklist of items that should be consistently evaluated during the assessment.

In general, specialized assessments are conducted by treatment program personnel or specially trained health care providers. Structured assessment interviews are considered desirable tools for professionals because of this perceived "quantifiability, reliability, validity, standardization, and recordability."¹⁴

Two structured assessments are available: the Structured Clinical Interview for DSM-IV (SCID) and the Diagnostic Interview Schedule (DIS) for DSM-IV. These are commercially available products that may require special training for proper use. The SCID is a multi-module assessment that covers:

• Substance use disorders
• Psychotic disorders
• Mood disorders
• Anxiety disorders
• Somatoform disorders
• Eating disorders
• Adjustment disorders
• Personality disorders

It takes a trained clinician approximately 30 minutes to administer the 35 SCID questions that probe for alcohol abuse or dependence. The DIS is a highly structured interview that does not require clinical judgment and can be used by non-clinicians. The DIS assesses both current and past symptoms and is available in a computerized version. It has been translated into a number of languages, including Spanish and Chinese.

Agencies that assist victims of alcohol abuse and domestic violence whose safety will be jeopardized by the continued use of substances need to simultaneously address sobriety and safety issues. Ideally, an agency will provide services coordinated for domestic violence and substance abuse. Since this is not always the case, there are some considerations to follow when referring clients to a substance abuse provider:

• Will the assessment place the client at further risk?
• What assurance does the client need to feel comfortable in following through with the referral?
• What information does the client need to follow through with the referral? If the client is referred to an off-site location, does she know where it is and how to get there?
• Are there barriers that could prevent the client from keeping the appointment? Does she have transportation or child care needs?

Assessment involves five important tasks:¹⁵

• Assistance in diagnosing of the problem.
• Establishing the severity of the problem.
• Developing a treatment plan.
• Defining a baseline that can be used to evaluate a client's progress in treatment.
• Increasing the client's motivation to attend treatment.

A variety of methods may be used to assess the client, including medical examinations, clinical interviews, formal instruments and questionnaires. Areas of assessment include alcohol use, social and family relationships, psychological functioning, legal status, medical conditions, and employment and educational status. Urine tests may be threatening to women who have been sexually abused and are not always necessary for assessment. Drug tests are most commonly done to monitor treatment compliance.