How to Apply The Core Resource on Alcohol in Clinical Practice
The Healthcare Professional’s Core Resource on Alcohol consists of 14 concise, practical articles created to help you deliver evidence-based alcohol healthcare. If you’re wondering where to begin, the “roadmap” below can help.
Roadmap for Applying the Core Resource
Here, we sort the Core articles broadly into “how-to content” and “context for care” to show how they could be applied in different aspects of your practice. This allows you to focus first on what’s now most important to you and your patients.
- How-to content: Core articles that support a workflow for evidence-based alcohol healthcare
- Context for care: Core articles that support better care through deeper understandings
All articles offer free CME/CE credit for physicians, physician assistants, nurses, psychologists, and pharmacists.
Step 1: Screen for Heavy Drinking
- Use one of the following brief tools recommended by the U.S. Preventive Services Task Force
- NIAAA Single Alcohol Screening Question
How many times in the past year have you had...
4 or more drinks in a day? (for women)
5 or more drinks in a day? (for men)
A positive score for heavy drinking is 1 or more times in the past year.
- NIAAA Single Alcohol Screening Question
-
Do NOT use: The CAGE, which does not identify all patients who could benefit from a brief intervention
Step 2: Advise or Assess
If NO to heavy drinking
- Single-day drink limit = 1 for women, 2 for men
- Recommend abstinence when warranted.
If YES to heavy drinking
- Get the typical weekly drinking pattern for a fuller picture, then assess for AUD.
- Have the patient fill out an AUD symptom checklist [PDF] (148KB) that can identify a diagnosis of AUD and the level of severity.
Step 3: Brief Intervention
If NO to AUD (0-1 symptom)
- Ask permission: Start by setting the agenda to discuss alcohol use.
- Give feedback and advice: Discuss the patient’s current drinking, related risks, and goals.
- Link your concern about alcohol use with the patient’s relevant physical and mental health conditions and emphasize the benefits of cutting back.
- Advise cutting down by staying within the U.S. Dietary Guidelines or abstaining as warranted.
- Negotiate individualized drinking goals to include "no heavy drinking days" as needed.
- Check in: Ask what the patient thinks of this information.
- Build motivation: Briefly explore reasons for making a change, listening for the patient's own reasons.
- Offer support: Express empathy and encourage autonomy.
- Identify next steps: Work together to develop a plan for change.
If YES to AUD (2+ symptoms)
- Ask permission: Start by setting the agenda to discuss alcohol use.
- Give feedback and advice: Discuss the patient’s current drinking, related risks, and goals.
- Inform them that you believe they have alcohol use disorder, that they can get better, and that you’re willing to help.
- Link your concern about alcohol use with the patient’s other relevant physical and mental health conditions and emphasize the benefits of quitting.
- Advise quitting by cutting down gradually. If the patient is hesitant to abstain, then negotiate individualized drinking goals.
- Discuss treatment options. Consider prescribing an FDA-approved medication for AUD, providing a referral to specialty behavioral healthcare, and suggesting they try different mutual support groups.
- Check in: Ask what the patient thinks of this information.
- Build motivation: Briefly explore reasons for making a change, listening for the patient's own reasons. Use their responses to the AUD symptom checklist (see Step 2) as an opener, if applicable.
- Offer support: Express empathy and encourage autonomy.
- Identify next steps: Work together to develop a plan for change.
At Next Visit, Continue Follow-Up
- Revisit drinking goals.
- Acknowledge change is difficult.
- Affirm progress.
- Explore challenges and strategies to surmount them.
Context for care: Core articles that support better care through deeper understandings
- Connect alcohol use with health conditions and medication interactions. When pertinent, noting these connections during brief interventions can help build patients’ motivation to change.
- Gain insights about your patients who are at risk for, now have, or are recovering from alcohol-related problems. These articles can strengthen your ability to advise and assist these patients.
- Risk Factors: Varied Vulnerability to Alcohol-Related Harm (Topic 2)
- Neuroscience: The Brain in Addiction and Recovery (Topic 3)
- Stigma: Overcoming a Pervasive Barrier to Optimal Care (Topic 4)
- Alcohol Use Disorder: From Risk to Diagnosis to Recovery (Topic 8)
- Support Recovery: It’s a Marathon, Not a Sprint (Topic 13)
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