Ms. Martinez: Do you think I’m an alcoholic?

Physician: Based on what you’ve said, you do have signs of alcohol dependence. Your depressed mood, insomnia, and fatigue may well be caused by your heavy drinking, and if so, they usually go away within a couple of weeks of stopping. So really, the drinking is the first thing we need to deal with.

Ms. Martinez: It’s kind of a relief to talk about it. I’ve been so alone with it. I‘m so ashamed.

Physician: Listen, it can happen to anybody. Why don’t we talk about where we go from here? There are a couple of options… You need some treatment. I could refer you to an addiction specialist or a treatment program, or I could prescribe some medication and see you right here in the office. Either way, it’s best if you quit drinking altogether.

Ms. Martinez: Yes, I think so too. I’ve tried to control it, but I just couldn’t do it.

Physician: Shall we talk about ways to quit? Ms.

Martinez: Yeah, I’m ready. I really want to quit.

Physician: OK – do you have a preference regarding referral or treatment here?

Ms. Martinez: I’d like to try that medication – is it the one that makes you sick?

Physician: Well that’s one option, but there are newer medications that work by restoring brain changes caused by dependence. Let’s discuss those first and see which one might work best for you. After that, my nurse will meet with you to tell you more about the medication and how to stay abstinent.

Ms. Martinez: OK.

Several medications are now available for treating alcohol dependence. They have been shown to help patients reduce drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence. The effectiveness of these medications will be maximized if you systematically address patient adherence issues, as is true in treating any chronic illness.

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