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HOW TO HELP PATIENTS: A CLINICAL APPROACH |
ALCOHOL USE DISORDERS (abuse or dependence)
Advise and Assist (Brief Intervention)
- State your conclusion and recommendation clearly:
- “I believe that you have an alcohol use disorder. I strongly recommend that you quit drinking and I’m willing to help.”
- Relate to the patient's concerns and medical findings if present.
- Negotiate a drinking goal:
- Abstaining is the safest course for most patients with alcohol use disorders.
- Patients who have milder forms of abuse or dependence and are unwilling to abstain may be successful at cutting down. (See Step 3 for At-Risk Drinking.)
- Consider referring for additional evaluation by an addiction specialist, especially if the patient is dependent. (See page 23 for tips on finding treatment resources.)
- Consider recommending a mutual help group.
- For patients who have dependence, consider
- the need for medically managed withdrawal (detoxification) and treat accordingly (see page 31).
- prescribing a medication for alcohol dependence for those who endorse abstinence as a goal (see page 13).
- Arrange followup appointments, including medication management support if needed (see page 17).
At Followup: Continue Support
REMINDER: Document alcohol use and review goals at each visit (see page 27 for downloadable progress notes). If the patient is receiving a medication for alcohol dependence, medication management support should be provided (see page 17).
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Was the patient able to meet and sustain the drinking goal?
- Acknowledge that change is difficult.
- Support efforts to cut down or abstain, while making it clear that your recommendation is to abstain.
- Relate drinking to problems (medical, psychological, and social) as appropriate.
- If these measures are not already being taken, consider
- referring to an addiction specialist or consulting with one.
- recommending a mutual help group.
- engaging significant others.
- prescribing a medication for alcohol dependent patients who endorse abstinence as a goal.
- Address coexisting disorders—medical and psychiatric—as needed.
- Reinforce and support continued adherence to recommendations.
- Coordinate care with a specialist if the patient has accepted referral.
- Maintain medications for alcohol dependence for at least 3 months and as clinically indicated thereafter.
- Treat coexisting nicotine dependence for 6 to 12 months after reaching the drinking goal.
- Address coexisting disorders—medical and psychiatric—as needed.
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