Options for People Who are Thinking About Their Drinking

Decision Aid Booklet Overview for Providers

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The purpose of the decision aid is to help patients who may be drinking at a level of concern decide whether they want to:
  • Cut down
  • Stop
  • Make no changes at this time
For patients who are considering changing their drinking, the decision aid provides information on 5 types of treatments that help patients:
  • Counseling
  • Peer support
  • Medications
  • Changing on their own
  • Group-based treatment

Here are some things your patient will learn from the decision aid:

  • The definition of alcohol use disorder is having ≥2 of 11 symptoms due to drinking (for DSM-5).
  • Many patients recover from alcohol use disorder while continuing to drink below recommended limits.
Treatments shown effective in randomized controlled trials:
  • Naltrexone and acamprosate are effective FDA-approved medications for treating alcohol use disorder.
  • Both help patients who are cutting down or stopping, but most trials focused on stopping.
  • Effective approaches to 1:1 counseling are: cognitive behavioral therapy, motivational enhancement therapy, 12-step facilitation, community reinforcement approach.
What we know from other research:
  • Disulfiram is effective for stopping drinking if adherence is monitored.
  • Outpatient treatment is as effective, or more effective, than inpatient treatment.
  • Engagement with Alcoholics Anonymous (AA) is associated with improved outcomes.
  • Peer support options other than AA include: Moderation Management (for patients who want to cut down) and SMART Recovery (CBT-based, non-spiritual), and 2 others; less research has been done on these programs.
  • The typical group-based, 12-step treatment that is available in most communities has never been evaluated in a randomized controlled trial (but many people report benefitting).
What we know is NOT effective:
  • Confrontational approaches have been shown to be ineffective.
  • Programs that make you drink a lot until you get sick do not work.
  • Patients don't need to hit “rock bottom”; changing earlier may be easier.
  • “Detox”—medical management of alcohol withdrawal—is important for many patients but if used alone it is not effective treatment and needs to be followed by effective treatment.
Other information that might be helpful to your discussion:
  • Naltrexone (the medication for treating alcohol use disorders) and naloxone (used to treat overdose) are two different medications.
  • For patients who are in at least 1 year of recovery from alcohol use disorders the chance of relapse 3 years later is:
  • For patients who abstain: 6% relapse
  • For patients who drink below recommended limits: 22% relapse
  • For patients who drink above recommended limits: 40% relapse