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HOW TO HELP PATIENTS WHO DRINK TOO MUCH: A CLINICAL APPROACH

Step 1 Ask About Alcohol Use

Prescreen: Do you sometimes drink beer, wine, or other alcoholic beverages?
No or Yes
No
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Yes
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Screening complete.

Ask the screening question about
heavy drinking days:

How many times in the past year
have you had . . .

5 or more drinks in a day? (for men)4 or more drinks in a day? (for women)
2 arrows pointing down from the previous questions to a checkbox.

One standard drink is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof spirits — see chart on page 24.




If the patient used a written self-report (such as the AUDIT p. 11), START HERE
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Is screening positive?

  • 1 or more heavy drinking days or
  • AUDIT score of ≥ 8 for men or ≥ 4 for women
Arrow down to next question - Is screening positive?
No or Yes
No
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 Yes
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  • Advise staying within these limits:
Maximum Drinking Limits
For healthy men up to age 65—
  • no more than 4 drinks in a day AND
  • no more than 14 drinks in a week
For healthy women (and healthy men over age 65)—
  • no more than 3 drinks in a day AND
  • no more than 7 drinks in a week
  • Recommend lower limits or abstinence as medically indicated; for example, for patients who
    • take medications that interact with alcohol
    • have a health condition exacerbated by alcohol
    • are pregnant (advise abstinence)
  • Express openness to talking about alcohol use and any concerns it may raise
  • Rescreen annually
 
  • Your patient is an at-risk drinker. For a more complete picture of the drinking pattern, determine the weekly average:
  • On average, how many days a week do you have an alcoholic drink?
 
X
  • drinks do you have?
  • Record heavy drinking days in the past year and the weekly average in the patient's chart (see page 27 for a downloadable baseline progress note).
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Go To Step 2

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