Fast Five Quiz: Helping Patients With New Year's Resolutions

George D. Harris, MD

Disclosures

December 12, 2018

Hospitalize patients if they have a history of delirium tremens or if they have significant comorbidity. Consider inpatient treatment if the patient has poor social support, significant psychiatric problems, or a history of relapse after treatment.

Brief physician advice makes a difference. During the initial brief intervention, use explicit evidence; emphasize the consequences endured by the patient as a result of alcohol abuse. Be empathic and nonjudgmental. Avoid arguments about the diagnosis. Avoid use of the word alcoholic.

While a trial period of controlled drinking with careful follow-up might be appropriate for a diagnosis of alcohol abuse, this approach increases a physician's professional liability. Complete abstinence is the only treatment for alcohol dependence. Emphasize that the most common error is underestimating the amount of help that will be needed to stop drinking. The differential diagnosis between alcohol abuse and dependence can be a difficult judgment call.

If the patient has an antisocial personality (ie, severe problems with family, peers, school, and police before age 15 and before the onset of alcohol problems), recovery is less likely. If the patient has primary depression, anxiety disorder, or another potentially contributory disorder (the other disorder must antedate the problems with alcohol or it must be a significant problem during long periods of sobriety), treat this primary problem aggressively.

Read more on the treatment of alcoholism.

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