Guidelines for the treatment of alcohol problems.

Summary of recommendations vii 1. Introduction 1 • Purpose of the guidelines 1 • Structure of the guidelines 1 • Evidence-based health care 3 • Community and population approaches to alcohol problems 4 • A note on terminology 4 2. Prevalence of alcohol consumption and related harms in Australia 7 • Prevalence of alcohol use 7 • Alcohol-related harm 8 3. Screening, assessment and treatment planning 13 • Screening 13 • Comprehensive clinical assessment 21 • Treatment planning 32 4. Brief interventions 41 • Who to target for brief interventions 41 • How to deliver brief interventions 42 • Who can deliver brief interventions? 43 • Where should brief interventions be delivered? 43 • Limitations of brief intervention 45 5. Alcohol withdrawal management 49 • Alcohol withdrawal syndrome: Clinical presentation 49 • Assessment and treatment matching 51 • Supportive care 57 • Medications for managing alcohol withdrawal 61 • Treating severe withdrawal complications 68 • Wernicke–Korsakoff’s syndrome 76 6. Psychosocial interventions for alcohol use disorders 81 • Overview of psychosocial interventions 81 • When to use psychosocial interventions 82 • Choosing psychosocial interventions: a stepped care approach 82 • Motivational interviewing 85 • Cognitive behavioural interventions 86 • Relapse prevention strategies 89 • Residential rehabilitation programs 89 7. Pharmacotherapies for alcohol dependence 93 • Naltrexone 93 • Acamprosate 96 • Combined acamprosate and naltrexone 98 • Disulfiram 98 • Other medications 101 • Integration with psychosocial treatments 102 • Increasing medication adherence 102 • Selecting medications for individual patients 103 8. Self-help programs 107 • Alcoholics Anonymous 107 • SMART RecoveryR 110 • Self-help for families 111 9. Specific populations 115 • Adolescents and young people 115 • Pregnant and breastfeeding women 121 • Indigenous Australians and people from other cultures 130 • Older people 135 • Cognitively impaired patients 138 10. Comorbidities 145 • Physical comorbidity 145 • Co-occurring mental and alcohol-use disorders 147 • Polydrug use and dependence 153 11. Aftercare and long-term follow-up 161 • Aftercare 161 • Working with the persistent problem drinker 161 Appendixes 165 • Appendix 1 Screening and diagnostic instruments 167 • Appendix 2 Diagnostic criteria for alcohol use disorders 195 • Appendix 3 Withdrawal scales 197 • Appendix 4 Alcohol and drug interactions 202 • Appendix 5 Getting through alcohol withdrawal: A guide for patients and carers 205 • Appendix 6 A guide for people with alcohol-related problems 208 • Appendix 7 Disulfiram Agreement 213 • Appendix 8 Treatment guidelines for mental disorders 214 • Appendix 9 Standard drinks 215 Glossary 221 Acronyms 225 References 22