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Like all medicine issues, alcohol treatment has come a long way in the past decades. In the past 25 years, important strides have been made in understanding alcohol problems and diverse intervention approaches have been developed. Alcohol problems are no longer viewed as a unitary, "all-or-nothing" clinical entity (e.g. "alcoholism") for which there is a single best treatment. Rather, alcohol problems are now broadly conceptualized as disorders that range from mild forms to very severe manifestations, with treatment considerations varying in accordance with the severity and unique characteristics of the individual's problem and situation. Before the clinician and client begin the treatment process, a comprehensive assessment is essential. The primary aims are two-fold: (a) to assess the severity of problems related to drinking and degree of alcohol dependence (i.e. none, mild, moderate, severe); and (b) to determine which intervention approach and level of treatment (e.g. brief vs. intensive) is most appropriate for this client. A clear picture is needed of the physiological, social and behavioral antecedents and consequences of alcohol problems. However, alcohol use and problems must also be understood and interventions applied considering the environment in which the individual is embedded. Assessment is not just a discrete step occurring prior to treatment. Rather, it is a systematic, continuous process which elucidates the initial clinical impression of the individual and alcohol problem, aids in the formulation of a treatment plan, helps match the client to an appropriate intervention, provides feedback on the course of treatment and evaluates treatment outcome. The severity and specific manifestations of alcohol problems can differ widely between individuals. During the assessment, the clinician's goal is to gain knowledge about the particular kind of alcohol problem an individual is experiencing and to understand the evolution of the individual's alcohol problem over time. The domains of interest include the client's physical or medical condition, the environment in which the drinking occurs, the frequency of drinking and amount of alcohol consumed, the drinking history, the consequences of alcohol use, and past treatment history. Individual clients will vary greatly along these domains and gathering specific information about these assessment variables allows the clinician to define and prioritize issues for intervention. Using a variety of assessment modalities, the clinician seeks to determine the individual client's characteristics and his/her life situation, which ultimately influence treatment decisions and contribute to treatment outcome. Although assessment allows the clinician to characterize the individual and the nature of the alcohol problem, it also yields clinical benefits. For example, giving individualized feedback based on assessment results can enhance motivation for and commitment to behavior change and can help clients formulate personal goals for improvement. And this psychological touch may be the most essential element in the success of the patient's alcohol treatment.
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