Management of problem drinking presents the general practitioner with similar challenges and rewards to those associated with the management of other chronic conditions.
This article presents a framework for managing alcohol problems in general practice based on national guidelines for the treatment of alcohol problems.
General practitioners are well placed to undertake the management of drinking problems following an assessment of the amount of alcohol taken and the risks this poses for the individual and the people around them. This assessment starts the process of engagement and reflection on drinking habits and will inform the appropriate management approach. Brief interventions can result in reduction in drinking in nondependent drinkers. For dependent drinkers, treatment steps include assessing need for withdrawal management and developing a comprehensive management plan, which includes consideration of relapse prevention pharmacotherapy and psychosocial interventions. The patient’s right to choose what they drink must be respected, and those who continue to drink in a problematic way can still be assisted, with compassion, within a harm reduction framework.
Problem drinking has similar characteristics to many of the chronic conditions routinely managed in the general practice setting. The management of chronic conditions can at times be challenging and time consuming. However, the majority of Australian general practitioners find dealing with chronic conditions more rewarding and satisfactory if they have clear treatment goals.1
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Table 3, on page 581 of the article Problem drinking: management in general practice by Demirkol A, et al, (AFP August 2011) contains an error, made in the process of preparing the paper for publication. The last three lines of the table referring to medications for alcohol dependence and use in cirrhosis, renal failure and heart disease may be misinterpreted. The correct details are:
* acamprosate can use in cirrhosis (except Childs C) and in heart disease; contraindicated in renal failure
* naltrexone contraindicated in cirrhosis; use with precaution in renal failure; can use with heart disease
* disulfiram contraindicated in all of cirrhosis, renal failure or heart disease.
An updated version appears here.
The Editors apologise for any inconvenience this error many have caused.