Why don't university clinics see alcohol-related problems?

[SeaSquirt]

I've been exploring the clinic sites for different universities and they always have a list of people they won't see. (Ex: Children under 3, people who want IQ and personality tests to satisfy their curiosity or for the fun of it, etc.)

Alcohol-related problems are almost always on the exclusion list. Why? I know alcohol dependence and abuse can be big problems on college campuses.

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[erg923]

I've been exploring the clinic sites for different universities and they always have a list of people they won't see. (Ex: Children under 3, people who want IQ and personality tests to satisfy their curiosity or for the fun of it, etc.)

Alcohol-related problems are almost always on the exclusion list. Why? I know alcohol dependence and abuse can be big problems on college campuses.

Well I can certainly understand the children under 3 and people who want to be tested for fun (what a waste of valuable mental health resources...).
The alcohol thing seems somewhat unusual, as I saw many clients with alcohol abuse/dependence at my university's clinic, however, most had other axis I diagnosis as well. University clinics are limited in the scope of services they can provide since they are generally just staffed with psychologists and grad students, and typically don't have consulting psychiatrists for management of comorbid medical issues or medication. I would also say that clients who have heavy alcohol dependencies can have medical complications due to heavy drinking as well (DTs, low thiamine levels) When this is the case, or at least a high risk, these patients are best handled in other environments or by medical trained mental health experts. Also, treating chemical dependency, and chemical dependency only, is generally not a specialty area of many psychologists. Therefore, it is quite plausible that many clinics feel they don't have the expertise to fully treat full blown etoh/drug dependencies,..hence, they refer these clients to more appropriate and specialized centers and/or therapists.

 

[PsyDr]

i would imagine liability issues also come into play

 

[Therapist4Chnge]

I believe it is both for liability and for scope of practice limitations. I've spoken with a few centers and they all refer out for moderate to severe EDs, alcohol, and substance abuse cases. If they can't properly treat them, a referral is best anyway.

 

[SeaSquirt]

i would imagine liability issues also come into play

What do you mean by liability issues?

 

[Ollie123]

What do you mean by liability issues?

Alcoholism generally involves more sizable medical issues than things like depression and anxiety.

For example, a severe alcoholic who quits drinking NEEDS medical treatment because unlike even other serious drugs (heroin), alcohol withdrawal can, and does, kill people outright. Not via some secondary reaction (depression leading to suicide), the withdrawal itself can kill you.

I imagine that is the major reason.

That being said, I find it hard to believe that NO alcohol abuse clients are seen - frankly its probably rather difficult to find clients who DON'T have some degree of alcohol issues.

Its also possible the reason the psychology clinic doesn't handle it is because there is another resource on campus devoted fully to it. For example, in addition to liability, we don't see many folks with alcohol use concerns because we have a separate center devoted to it that the counseling folks run that has actual university support. Clinical psych students can work there if they want (and many do) its just separate from the clinic itself.

 

[Therapist4Chnge]

If someone is a binge drinker and gets sloshed on weekends, I don't think that would exclude them, but someone with alcohol dependence is where it gets problematic (for liability and scope of practice). They can't be properly treated if they are dry heaving, having DTs, the shakes, etc.....that is why they need detox.

 

[ohiopsychology]

We see people with substance use disorders in our clinic. I guess each place has different resources.

 

[socialcog]

Well I can certainly understand the children under 3 and people who want to be tested for fun (what a waste of valuable mental health resources...).
The alcohol thing seems somewhat unusual, as I saw many clients with alcohol abuse/dependence at my university's clinic, however, most had other axis I diagnosis as well. University clinics are limited in the scope of services they can provide since they are generally just staffed with psychologists and grad students, and typically don't have consulting psychiatrists for management of comorbid medical issues or medication. I would also say that clients who have heavy alcohol dependencies can have medical complications due to heavy drinking as well (DTs, low thiamine levels) When this is the case, or at least a high risk, these patients are best handled in other environments or by medical trained mental health experts. Also, treating chemical dependency, and chemical dependency only, is generally not a specialty area of many psychologists. Therefore, it is quite plausible that many clinics feel they don't have the expertise to fully treat full blown etoh/drug dependencies,..hence, they refer these clients to more appropriate and specialized centers and/or therapists.

I think this response hits the strongest reasons why this population is not or shouldn't be seen at a university clinic. The medical attention aside, I think each CD patient (as heterogeneous as this population can be) has their own set of variables that will ultimately become the individualized treatment plan...which could include a step down plan involving multiple levels of care (ie: detox--> rehab,--> intensive outpatient, --> array of outpatient therapy....etc.). I am not sure if most universities can offer a full spectrum of services that many addicts might need for successful trajectory.

I don't know. I don't treat this population--I spent some years in assessment and referral but never in a clinical capacity.