Key points
- Interventions should match the category of drinking.
- Five medications in particular are useful for treating people with alcohol dependence in a primary care practice.
- Assisted alcohol withdrawal is a treatment option for people with alcohol dependence.
| Category of drinking | Appropriate intervention |
|---|---|
| Low-risk drinking | Primary prevention |
| At-risk drinking | Brief intervention |
| Alcohol dependence | Specialized treatment |
Brief interventions
- People who drink at an at-risk level are often not willing to accept a referral to a specialized addiction service.
- Brief advice from a physician is effective in reducing alcohol consumption, injuries, emergency room visits, hospital days and health care costs in people with alcohol problems.
Read more about brief interventions for alcohol problems.
Specialized treatment
Psychosocial interventions
- The most widely used empirically supported psychosocial approaches are motivational interviewing and cognitive-behavioural therapy (CBT), including coping skills training, relapse prevention and behavioural couples therapy.
- Psychosocial interventions can be used in various treatment settings. They can be implemented individually or in groups, and can be delivered by a range of health care workers
- Psychological treatments can be brief or intensive and specialized (e.g., CBT, couples therapy).
- Motivational strategies are often used early in treatment and engage clients in the change process.
Read more about motivational strategies.
- Cognitive-behavioural or other specialized therapies may be added in treatment to help clients develop the skills they need to maintain change.
Pharmacotherapy
Treating alcohol dependence
Five medications are useful for treating people with alcohol dependence in a primary care practice:
- disulfiram
- naltrexone
- acamprosate
- topiramate
- baclofen.
When discussing medication choices with clients, consider:
- client preference
- side-effects
- cost
- availability.
Read more about using medications to treat alcohol dependence.
Assisted alcohol withdrawal
Indications for office management of alcohol withdrawal:
- The client is committed to abstinence and a treatment plan. (There is little value in planned treatment of withdrawal if the person is likely to relapse immediately.)
- The client does not have a history of severe withdrawal (seizures or delirium tremens).
- On completion of treatment, the client agrees to go home (if socially stable), to a withdrawal management service or, if necessary, to a hospital emergency room.
- You have a room in your clinic where the client can spend several hours, and you or the office nurse has the time to assess the client every one to two hours.
Read more about alcohol withdrawal.
Download the Clinical Institute Withdrawal Assessment for Alcohol Scale.
Evidence summary
Enoch, M.A. & Goldman, D. (2002). Problem drinking and alcoholism: Diagnosis and treatment. American Family Physician, 65(3), 441–448.
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.
Alcohol problems quick reference: