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HOW TO HELP PATIENTS: A CLINICAL APPROACH

AT-RISK DRINKING (no abuse or dependence)

Step 3 Advise and Assist (Brief Intervention)

  • State your conclusion and recommendation clearly:
    • “You are drinking more than is medically safe.” Relate to patient’s concerns and medical findings, if present. (Consider using the chart on page 25 to show increased risk.)
    • “I strongly recommend that you cut down (or quit).” (See page 29 for advice considerations )
  • Gauge readiness to change drinking habits:
    “Are you willing to consider making changes in your drinking?”
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Is the patient ready to commit to change at this time?
No or Yes
No
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Yes
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Do not be discouraged—ambivalence is common. Your advice has likely prompted a change in your patient’s thinking, a positive change in itself. With continued reinforcement, your patient may decide to take action. For now,

  • Restate your concern about his or her health.
  • Encourage reflection: Ask patients to weigh what they like about drinking versus their reasons for cutting down. What are the major barriers to change?
  • Reaffirm your willingness to help when he or she is ready.

 

  • Help set a goal: Cut down to within maximum limits (see Step 1) or abstain for a period of time.
  • Agree on a plan, including
    • what specific steps the patient will take (e.g., not go to a bar after work, measure all drinks at home, alternate alcoholic and non-alcoholic beverages)
    • how drinking will be tracked (diary, kitchen calendar)
    • how the patient will manage high-risk situations
    • who might be willing to help, such as a spouse or nondrinking friends
  • Provide educational materials. See page 26 for "Strategies for Cutting Down" and page 27 for other materials available from NIAAA.

Step 4 At Followup: Continue Support

REMINDER: Document alcohol use and review goals at each visit (see page 27 for downloadable progress notes).

Was the patient able to meet and sustain the drinking goal?
No or Yes
No
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Yes
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  • Acknowledge that change is difficult.
  • Support any positive change and address barriers to reaching the goal.
  • Renegotiate the goal and plan; consider a trial of abstinence.
  • Consider engaging significant others.
  • Reassess the diagnosis if the patient is unable to either cut down or abstain. (Go to Step 2.)
  • Reinforce and support continued adherence to recommendations.
  • Renegotiate drinking goals as indicated (e.g., if the medical condition changes or if an abstaining patient wishes to resume drinking).
  • Encourage the patient to return if unable to maintain adherence.
  • Rescreen at least annually

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