A scaled approach (see Levels of Screening for Alcohol-Related Problems) can help identify patients who need more detailed questions. Several validated questionnaires are available, including the AUDIT (Alcohol Use Disorders Identification Test) and the CAGE questionnaire.
Clinical Calculator:AUDIT control questionnaire on alcohol consumptionicon
Treatment of alcohol-related disorders
- Rehabilitation programs
- Outpatient counseling
- Self-help groups
- Consider medications (eg, naltrexone, disulfiram, acamprosate)
All patients should be advised to decrease alcohol consumption to below risk levels.
For patients identified as at-risk drinkers, treatment can begin with a brief discussion of the medical and social consequences and a recommendation to reduce or stop drinking, with follow-up on compliance (see table Short interventions for related problems. alcohol).
Brief interventions for alcohol-related problems
For patients with more severe problems, particularly after less intensive measures have failed, a rehabilitation program is often the best approach. Rehabilitation programs combine psychotherapy, including self-based and group therapy, with medical supervision.
- For most patients, outpatient rehabilitation is sufficient; How long patients stay enrolled in programs varies, typically weeks or months, but longer if needed.
- Inpatient rehabilitation programs are reserved for patients with more severe alcohol addiction and those with significant medical and psychiatric co-morbidities and substance abuse problems.
- The duration of treatment is usually shorter (usually days or weeks) than that of outpatient programs and may be required in part by patient insurance.
Psychotherapy includes techniques that increase motivation and teach patients to avoid situations that lead to drinking. The social support of abstention, including support from family and friends, is essential.
Maintenance
It is difficult to maintain the state of sobriety. Patients should be warned that after a few weeks, once they recover from the last seizure, they will likely look for an excuse to start drinking again.
They should also be advised that although they may be able to drink in a controlled manner for a few days or, rarely, for a few weeks, they will in all likelihood eventually start drinking out of control again.
- In addition to the counseling provided in outpatient and inpatient treatment programs for alcoholics, self-help groups and some medications can help prevent relapse in some patients.
Alcoholics Anonymous is the most popular self-help group. Patients need to find a group of Alcoholics Anonymous they are comfortable with. Alcoholics Anonymous provide patients with sober friends that are always available and an environment in which to socialize without drinking.
Patients also listen to others discussing the same rational justifications that they themselves have always used to justify their drinking.
The help they give to other patients with alcohol use disorder can give them the respect and self-confidence they previously found only in alcohol. Many patients with alcohol use disorder are reluctant to turn to Alcoholics Anonymous and find individual counseling or group or family therapy more acceptable.
- There are alternative organizations, including LifeRing Secular Recovery, for patients seeking another kind of approach.
- Drug therapy should be used in conjunction with counseling rather than as the only treatment.
The National Institute on Alcohol Abuse and Alcoholism provides a guide for clinicians for medical management and drug therapy for alcohol addiction, as does the American Psychiatric Association, along with a number of other publications and resources for both healthcare professionals and for patients.