Diagnosis and Management of Alcohol Problems

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Brief Intervention

Some patients are reluctant to seek formal, specialized treatment. Brief (one-four sessions) therapeutic techniques have been developed for physicians to use in the office. These techniques have been studied primarily for patients who meet the ICD-10 diagnosis of harmful use, rather than chronic alcoholics, but some studies indicate that they may also be helpful for patients who are alcohol dependent. For alcoholics who do not accept referral, the physician in the office can initiate a brief intervention with a commitment from the patient that if this does not prove adequate, he or she will pursue more intense, specialized treatment.

Brief interventions are more effective than no treatment and often as effective as more extensive treatment. Given the severity of problems that alcohol causes the patient, the family, and society as a whole as well as the low level of use of medical resources required for a brief intervention, brief interventions for alcohol problems should be incorporated into medical practice.
These are identified six common elements of effective brief interventions:

1. Personalized feedback to the patient regarding status of some important facet of the patientís drinking, such as quantity of consumption, adverse consequence of drinking on quality of life or health, or biochemical indices of problematic drinking.
2. Responsibility for change belongs to the patient. The physician can assist but does not abrogate patientsí personal responsibility for changing their behavior.
3. Advice on the need for change should be given in a direct, albeit supportive, manner.
4. Options for various strategies to change behavior should be offered to the patient for example, involvement in peer support groups and alcohol-free leisure-time activities.
5. Empathic, warm, and supportive practitioner style is more effective than confrontation. Several other alcohol treatment studies have indicated that empathy is a key characteristic of effective alcohol counselors.
6. Self efficacy should be emphasized. The patient needs to appreciate that he or she can change for the better.

Interestingly, a diminished sense of self efficacy was found to be a major precipitant to alcohol relapse following treatment.
Ultimately, to maintain sobriety, the alcoholic must make personal decisions regarding the costs and benefits of not drinking. The physician might assist this effort by using a "decisional balance." The patient should reflect on and write down the advantages and costs of drinking. Getting the patient to write down the external circumstances and mental states that preceded drinking may assist the patient to better understand the nature of the problem. Indeed, some studies suggest that simply monitoring occurrence of a problem behavior diminishes its frequency.

If the patient values his or her relationships with family members, they should be involved in therapy, if possible. Finally, patients may be expected to vary widely on how motivated they are to change their drinking behavior. Some will have given their use of alcohol little thought before this time. For those patients it may only be possible to offer feedback on the problem, provide some written instructional information on alcohol, and begin the dialogue about seeking treatment by assuring them that support is available when they are ready.

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