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What's the Same, What's New in This Update

Same approach to screening and intervention

The approach to alcohol screening and intervention presented in the original 2005 Guide remains unchanged. That edition established a number of new directions compared with earlier versions, including a simplified, single-question screening question; more guidance for managing alcohol-dependent patients; and an expanded target audience that includes mental health practitioners, since their patients are more likely to have alcohol problems than patients in the general population.11,12

In the “how-to” section, two small revisions are noteworthy. Feedback from Guide users told us that some patients do not consider beer to be an alcoholic beverage, so the prescreening question on page 4 now reads, “Do you sometimes drink beer, wine, or other alcoholic beverages?” And on page 5, the assessment criteria remain the same, but the sequence now better reflects a likely progression of symptoms in alcohol use disorders.

Updated and new supporting materials

  • Updated medications section. The section on prescribing medications (pages 13–16) contains added information about treatment strategies and options. It describes a newly approved, extended-release injectable drug to treat alcohol dependence that joins three previously approved oral medications.
  • Medication management support. Patients taking medications for alcohol dependence require some behavioral support, but this doesn’t need to be specialized alcohol counseling. For clinicians in general medicine and mental health settings, the Guide now outlines a brief, effective program of behavioral support that was developed for patients who received pharmacotherapy in a recent clinical trial (pages 17–22).
  • Specialized alcohol counseling resource. For mental health clinicians who wish to provide specialized counseling for alcohol dependence, we’ve added information about a state-of-the-art behavioral intervention also developed for a recent clinical trial (page 31).
  • Online resources. A new page on the NIAAA Web site is devoted to the Guide and related resources ( See page 27 for a sampling of available forms, publications, and training resources.
  • New patient education handout. “Strategies for Cutting Down” provides concise guidance for patients who are ready to cut back or quit. The handout may be photocopied from page 26 or downloaded from, where it is also available in Spanish.
  • Transferred sections. Two appendix resources from the preceding edition (the sample questions for assessment and the preformatted progress notes for baseline and followup visits) are now available online at The previous “Materials from NIAAA” section is now part of the “Online Materials for Clinicians and Patients” on page 27.
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