Managing alcohol use disorders​

Strategies for managing more severe alcohol use disorders

Strategies for managing patients who are dependent on alcohol will differ, depending on whether the patient is willing to quit. Contrary to popular belief, patients with more severe problems are more interested in making a change than those with milder problems. However, because of the severity of their addiction, change is more difficult (Bertholet, 2009).

The patient who is not ready to quit

• Provide clear non-judgmental advice to quit drinking.
• Use motivational strategies. Ask open-ended questions and practise reflective listening. Encourage the patient to talk about the pros and cons of drinking and the pros and cons of abstinence. Using the decisional balance tool can be helpful (see the example below).
• Encourage regular follow-ups, with alcohol at the top of the agenda. Try to engage the patient in a discussion about alcohol use, without arguing or lecturing. Don't give up! It may take months or years before a person is ready to change.

Decisional balance exercise example

The patient who is willing to try to quit

 

• Recommend an inpatient or outpatient treatment program.
• Refer the patient to appropriate community resources.
• Recommend that the patient attend Alcoholics Anonymous or another support group.
• Screen for childhood and adulthood trauma and refer patients with posttraumatic stress disorder for concurrent trauma and addiction treatment.
• Prescribe medications: naltrexone, acamprosate and in certain cases, disulfiram.
• Provide ongoing supportive counselling for the patient and family.
• Monitor laboratory markers for signs of improvement or relapse.
• Provide ongoing treatment of medical complications.
• Provide encouragement and promote relapse prevention.