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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
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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
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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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