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).

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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.

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