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).
|
top
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).
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.
| |
top
Previous
| Table of Contents | Next