Alcohol problems: Ongoing care

Key points

  • Ongoing care can include relapse prevention, support groups and individual support.
  • Access to education or training, advisory services, peer support and social networks, and employment support are critical components of ongoing care.
  • Ongoing care is customized for each client and should take into account the type of alcohol problem the client has.

Monitoring and continuing care

  • Ongoing treatment and support are important because there is a high risk of relapse immediately following treatment. All treatment services need to pay attention to ongoing support.
  • Ongoing care can include relapse prevention, support groups and individual support for people who want to maintain the changes they have made in treatment.
  • Access to education or training, advisory services, peer support and social networks, and employment support may be included.

At-risk drinking

If the person is drinking at hazardous or harmful levels, follow-up should be determined by various factors, including level of alcohol consumption, presence of comorbidities and the person's choice.

At follow-up address whether:

  • the agreed drinking targets (and any other goals) have been achieved
  • any new concerns or problems have developed.

If there is no improvement in the person's alcohol consumption after brief advice, consider providing a further brief intervention or an extended brief intervention (if you are trained to deliver it).

Alcohol dependence

Immediate follow-up and subsequent treatments following alcohol withdrawal will usually be carried out by specialists in secondary care. If this has not occurred with a client, it is important to offer support in the primary care setting.

  • Stay in contact with the client over the long term and offer appropriate treatment if the person relapses. Once maintenance has been established and the person has been released from specialist care, maintain contact through primary care for at least three years:
    • Maintain contact using low-intensity monitoring. This may be done by telephone or through a brief appointment.
    • Whenever possible, there should be continuity of care, with the same health care professional maintaining contact with the person.
    • If the person relapses, offer immediate help.
  • Offer advice, reassurance and treatment.
    • Counselling should be continued for as long as the client needs it.
    • People who are dependent on alcohol often require long-term counselling by specialists (intensive treatment, not usually available in primary care).
  • Medications may be useful as an adjunct to counselling. Although medications are usually initiated in specialist settings, they are often continued in primary care for up to one year, and can be initiated by GPs.
    • The effectiveness of ongoing maintenance with medications should be monitored by the primary care team.
    • If a specialist service is not available or is not being used, consider initiating acamprosate in primary care (with continued counselling).

Read more about prescribing medications for alcohol dependence.

  • Cognitive-behaviour–based self-help manuals and mutual-aid groups (e.g., Alcoholics Anonymous) may benefit some people.
    • These approaches should be used as an adjunct to other treatments for people with mild or moderate alcohol dependence, not as a replacement for treatment.
    • Alcoholics Anonymous operates on the premise that alcoholism is a disease, and its goal is abstinence. It has a strong spiritual aspect, which is not suitable for everyone. Do not coerce clients into attending meetings.

Evidence summary

Kahan, M. & Watts, K. (Eds.). (2010). Dealing with alcohol problems. In Primary Care Addiction Toolkit. Toronto, ON: Centre for Addiction and Mental Health.

National Institute for Health and Clinical Excellence. (2011). Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (Clinical Guideline 115). London, UK: Author.

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I'm not sure about suggesting AA groups to people who have co-occurring mental health problems.
Posted on 31/01/14 3:07 PM.
Caroline, I'm doing a research project on that topic - please feel free to connect directly with me if you'd like to discuss.
Posted on 31/01/14 4:32 PM in reply to Caroline Hebblethwaite.