Helping Patients Who Drink Too Much

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), has released a new guide for health care practitioners to help them identify and care for patients with heavy drinking and alcohol use disorders. Helping Patients Who Drink Too Much: A Clinician's Guide is now available free online (www.niaaa.nih.gov) and in print, with a pocket version included.

About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about 1 in 4 currently has alcohol abuse or dependence. Although relatively common, these alcohol use disorders often go undetected in medical and mental health care settings. When effective methods are used for alcohol screening and brief interventions, however, research shows they can promote significant, lasting reductions in drinking levels and alcohol-related problems.

The 2005 edition of the Guide provides a research-based approach to alcohol screening and brief intervention for both primary care and mental health clinicians. It updates earlier NIAAA guidelines, which focused solely on primary care providers and used a lengthier screening process.

In the new Guide, alcohol screening is simplified to a single question about heavy drinking days. If a patient drinks heavily (5 or more drinks in a day for men or 4 or more for women), the Guide shows how to assess for symptoms of alcohol abuse or dependence. Whether the patient has an alcohol use disorder or is a heavy, at-risk drinker, the Guide offers streamlined, step-by-step guidance for conducting brief interventions and managing patient care.

"In updating this Guide, we wanted to make it easier for clinicians to screen patients," says NIAAA Director Ting-Kai Li, M.D. "Multi-step interviews can be impractical in the real world. The single screening question helps overcome a barrier that may have kept many practitioners from identifying and helping people who drink harmfully."

The Guide's target audience now includes mental health clinicians in recognition that alcohol use disorders are more common in mental health patients than in the general population. "Often the only care these patients receive is mental health care," notes Mark Willenbring, M.D., a psychiatrist and Director of NIAAA's Division of Treatment and Recovery Research. "Heavy drinking can interfere with the response to mental health treatment. Routine alcohol screening is important for these patients as well."

The 2005 edition of the Guide provides new and revised materials that support clinicians in conducting alcohol screenings, assessments, and brief interventions. Included are:

An optional written screening tool, provided in both English and Spanish

Patient education charts about U.S. adult drinking patterns and alcohol content in different beverage types and serving sizes

A new section about prescribing medications for alcohol dependence

New forms for recording patient baseline and progress notes

Resources for making referrals to treatment and support groups

A portable, pocket-sized version of the full Guide

Print copies of Helping Patients Who Drink Too Much: A Clinician's Guide, complete with the pocket version, can be ordered through NIAAA at 301-443-3860 or online at www.niaaa.nih.gov. The Guide may be downloaded from the NIAAA website as well. For training, a PowerPoint slide show on the Guide will be posted on the website in the near future.

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