While you will not be treating most medical complications of alcohol use, it’s important to ask patients about these things, especially as part of the motivational interviewing strategy. Identifying significant medical sequelae during an interview can be a powerful incentive for patients to consider the negative consequences of drinking. In essence, this comprehensive medical survey will help to “scare them sober.” From Treating Alcohol Use Disorder: A Fact Book (2023).
Phenobarbital is becoming more popular as a strategy for managing alcohol withdrawal syndrome (AWS) as clinicians gain more experience with it. A recent retrospective study compared phenobarbital with lorazepam for AWS and found that patients using phenobarbital had a shorter length of stay (2.8 vs 3.6 days) as well as fewer readmissions and emergency room visits after discharge (Hawa F et al, Cureus 2021;13(2):e13282). From Treating Alcohol Use Disorder: A Fact Book (2023).
Including family meetings in your treatment of alcohol-using patients (or any psychiatric patients, for that matter) can help you better understand treatment challenges and therefore help achieve long-term sobriety. But it can be awkward to facilitate such meetings, especially if you haven’t done many. This fact sheet presents some useful tips. From Treating Alcohol Use Disorder: A Fact Book (2023).
Disulfiram is an aversive treatment, causing a buildup of ethanol’s metabolite acetaldehyde in the serum, which in turn causes symptoms such as flushing, dizziness, nausea, and vomiting if patient consumes alcohol. Since disulfiram does not reduce cravings and any alcohol ingestion could result in a reaction, noncompliance can be common. Its use should be reserved for selective, highly motivated patients in conjunction with supportive and psychotherapeutic treatment. From Treating Alcohol Use Disorder: A Fact Book (2023).
Research has shown that consistent attendance at Alcoholics Anonymous (AA) meetings is at least as effective as any other treatment, and possibly more so. The two key ingredients of AA meetings are: ⦁ Making positive changes in social networks ⦁ Learning coping skills to maintain abstinence when in high-risk social situations. From Treating Alcohol Use Disorder: A Fact Book (2023).
Alcohol use disorder (AUD), as defined in the DSM-5, includes 11 criteria. While most experienced clinicians can diagnose AUD without going through a formal checklist of DSM symptoms, we suggest you try using this sheet during interviews. You are likely to find it helpful in at least two ways. First, you can use the criteria to more accurately categorize the severity of your patient’s AUD: ⦁ Mild: two DSM-5 criteria ⦁ Moderate: three to five DSM-5 criteria ⦁ Severe: more than five DSM-5 criteria Second, you can use the criteria to show your patient that there are relatively objective medical symptoms leading to the diagnosis of AUD. This lessens the stigma attached to the diagnosis and shows that you are a well-trained professional, enhancing your credibility and hopefully helping your patient trust your recommendations. From Treating Alcohol Use Disorder: A Fact Book (2023).
Regardless of what kind of treatment you choose for your patient, it’s important to remind yourself of the key feature of any successful treatment—a good treatment alliance. From Treating Alcohol Use Disorder: A Fact Book (2023).
Disulfiram blocks the breakdown of alcohol in the body, which leads to a buildup of a toxic compound that can cause a bad reaction in people who drink alcohol while taking the medication. Especially when combined with other types of therapy or support, it can help encourage people to stop using alcohol. From Treating Alcohol Use Disorder: A Fact Book (2023).
A key ingredient of cognitive behavioral therapy (CBT) for alcohol use disorder is discussing automatic negative thoughts that may trigger drinking (see “Cognitive Behavioral Therapy Techniques in Alcohol Use Disorder” for more information). This is a template of a worksheet you can use with your patients to facilitate this technique. Typically, you and your patient would fill out one of these worksheets together during a visit, and then you would ask your patient to do this exercise at least once every week as a homework assignment, and to bring the completed worksheet to the next visit for discussion. This template includes an example from the vignette discussed in the CBT fact sheet. You can download this template and adapt it as needed for your practice setting. From Treating Alcohol Use Disorder: A Fact Book (2023).