Center for Addiction Medicine

04/06/2007 - Helping Patients Who Drink too Much "Part I"

Drinking becomes too much when it causes or elevates the risk for alcohol-related problems or complicates the management of other health problems. Although individual responses to alcohol vary, epidemiological research shows men who drink five or more standard drinks in a day (or 15 or more per week) and women who drink four or more in a day (or 8 or more per week) are at increased risk for alcohol-related problems.

Health care providers should screen for alcohol addiction an abuse for a number of reasons. First, at-risk drinking and alcohol problems are common. About three in 10 U.S. adults drink at levels that elevate their risk for physical, mental and social problems. Of these heavy drinkers, one in four has alcohol abuse or dependence.

In addition, heavy drinking often goes undetected. In a recent study of primary care practices, patients with alcohol dependence received the recommended quality of care, including assessment and treatment, only 10 percent of the time.

Patients are also likely to be more receptive to advice than you expect. Moat patients don't object to being screened for alcohol use by clinicians and are open to hearing advice afterward.

Finally, as a medical professional, you are in a prime position to make a difference. Clinical trials have demonstrated that brief interventions can promote significant, lasting reductions in drinking levels in at-risk drinkers who are not alcohol dependent. Some drinkers who are dependent will accept referral to addiction treatment programs.

1. Ask about alcohol use.
Determine how screening will be approached and what method you will use. One example of a simple screening questionnaire is the Alcohol Use Disorders Identification Test (AUDIT), which is available online from the World Health Organization at www.who.org.

2. Assess for disorders
Determine where there is a maladaptive pattern of alcohol use causing significant impairment or distress? It is important to assess the severity and extent of all alcohol-related symptoms to determine a plan of management.
A list of symptoms is listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), Revised.

3. Advise and assist.
Is the patient ready to commit to change at this time?

If Yes:
• Help set a goal to cut down to a maximum limit or abstain for a period of time
• Agree on a plan and provide the appropriate resources
• Refer to an addiction specialist, if needed

If No:
• Restate your concern
• Encourage your patient to think about it
• Reaffirm your willingness to help

4. Follow-up and continued support
Was the patient able to meet and sustain the drinking goal?

If Yes:
• Reinforce support and continued adherence to the treatment plan
• Maintain medications
• Address coexisting disorders as needed

If No:
• Acknowledge that change is difficult
• Refer to an addiction specialist, recommend a help group, and/or prescribe medication
• Address coexisting disorders as needed
 

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