Alcohol Use: Managing alcohol use disorders

Patients with severe alcohol use disorder are more interested in changing their drinking patterns than those experiencing milder issues.

However, because of the severity of their addiction, change is more difficult (Bertholet, 2009).

The strategy for managing a patient’s problematic drinking use will vary according to the patient’s willingness to quit or reduce their drinking.

Use the following strategies with patients with an alcohol use disorder and are not ready to quit or reduce their alcohol consumption:

Provide clear, non-judgmental advice to quit or reduce 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.

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.