Summary of recommendations

RECOMMENDATION 1: All adult and youth (age 12-25) patients should be screened routinelya for alcohol consumption above low risk as defined in Canada’s Guidance on Alcohol and Health (CGAH).
(STRONG, MODERATE)

RECOMMENDATION 2: Individuals drinking at or below the CGAH low-risk levels can be offered brief education aimed at reinforcing safer alcohol consumption.
(STRONG, MODERATE)

RECOMMENDATION 3: Individuals drinking above the CGAH low-risk levels should be assessed for alcohol attributable risks and possible health or other problems attributable to alcohol use that might imply an underlying alcohol use concern.
(STRONG, MODERATE)

RECOMMENDATION 4: In individuals that exceed the CGAH low-risk thresholds but do not endorse alcohol-attributable problems, provide personalized information on alcohol risks and, where appropriate, advice on strategies to cut down consumption can be provided without pursuing a DSM-5 diagnosic assessment.
(STRONG, MODERATE)

RECOMMENDATION 5: In patients who exceed the CGAH low-risk thresholds and who subsequently report possible problems with alcohol consumption, move directly to a DSM-5 diagnostic interview for alcohol use disorder rather than further screening.
(STRONG, MODERATE)

RECOMMENDATION 6: Clinicians should use clinical parameters, such as past seizures or past delirium tremens, and the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) to assess the risk of severe alcohol withdrawal complications and determine an appropriate withdrawal management pathway.
(MODERATE, STRONG)

RECOMMENDATION 7: For patients at low risk of severe complications of alcohol withdrawal (e.g., PAWSS < 4), clinicians should consider offering non-benzodiazepine medications, such as gabapentin, carbamazepine or clonidine for withdrawal management in an outpatient setting (e.g., primary care, virtual).
(gabapentin: MODERATE, STRONG; carbamazepine, clonidine: LOW, STRONG)

RECOMMENDATION 8: For patients at high risk of severe complications of withdrawal (e.g., PAWSS ≥ 4), clinicians should offer a short-term benzodiazepine prescription, ideally in an inpatient setting (i.e., withdrawal management facility or hospital). However, where barriers to inpatient admission exist, benzodiazepine medications can be offered in outpatient settings if patients can be closely monitored.
(HIGH, STRONG)

RECOMMENDATION 9: All patients who complete withdrawal management should be offered ongoing AUD care.
(LOW, STRONG)

RECOMMENDATION 10: Adults and youth with mild to severe AUD should be offered information about and referrals to specialist-led psychosocial treatment interventions in the community.
(MODERATE, STRONG)

RECOMMENDATION 11: Adult patients with moderate to severe AUD should be offered naltrexone or acamprosate as a first-line pharmacotherapy to support achievement of patient-identified treatment goals.

Naltrexone is recommended for patients who have a treatment goal of either abstinence or a reduction in alcohol consumption.

Acamprosate is recommended for patients who have a treatment goal of abstinence.
(HIGH, STRONG)

RECOMMENDATION 12: Adult patients with moderate to severe AUD who do not benefit from, have contraindications to, or express a preference for an alternative to first-line medications can be offered topiramate or gabapentin.
(Topiramate: MODERATE, STRONG; Gabapentin: LOW, CONDITIONAL)

RECOMMENDATION 13: Adult and youth patients should not be prescribed antipsychotics or SSRI antidepressants for the treatment of AUD.
(MODERATE, STRONG)

RECOMMENDATION 14: Prescribing SSRI antidepressants is not recommended for adult and youth patients with AUD and a concurrent anxiety or depressive disorder.
(MODERATE, STRONG)

RECOMMENDATION 15: Benzodiazepines should not be prescribed as ongoing treatment for AUD.
(HIGH, STRONG)

RECOMMENDATION 16: Adults and youth with mild to severe AUD should be offered information about and referrals to peer-support groups and other recovery-oriented services in the community.
(MODERATE, STRONG)