Brief intervention

• Initiate a conversation about the patient’s alcohol use.
• Proceed with screening and diagnosis.

• Clearly describe the screening result.
• Discuss the implications on the patient’s health.
• Connect the health risks to the laboratory investigations and medical findings in lay terms (e.g., anxiety, insomnia, liver function tests, gastroesophageal reflux disease, blood pressure), if relevant.
• Discuss the patient’s health concerns and goals.
• Provide personalized recommendations.

Sample questions:

• “I think your drinking is putting your health at risk. What health goals are most important for you?”

• “I strongly recommend that you cut down or stop drinking. What has worked for you in the past?”

Assess the patient’s motivation and interest in changing their drinking.

Sample questions:

• “Are you interested in or considering making changes to your drinking?”
• “What would you lose or gain by cutting back on your drinking?”
• “On a scale of 1 to 10, how important is it to you to cut down on your drinking?”
  “How do you feel about my recommendation? Do you have any questions or concerns?”

If the patient expresses readiness to change:

• Express your support and offer encouragement.
• Affirm your confidence in the patient’s motivation and ability to change.
• Collaboratively set goals that are meaningful to the patient. Goals do not have to be limited to reducing or stopping alcohol use, and can include safer alcohol consumption. Share this list of tips and strategies to cut down.
• In line with the patient’s goals, provide a menu of options, including pharmacotherapy, psychosocial interventions, and recovery-oriented and community-based supports.
• Agree on a specific plan and a change date or schedule.
• Provide referrals to other health care services.
• Offer educational material, such as the public summary of Canada’s Guidance on Alcohol and Health, and connect the patient to social supports and community resources near them or available online.

If the patient does not express readiness to change:

• Restate your concern about the patient’s health.
• Ask about any barriers to change the patient may be experiencing, and invite the patient to consider how these could be navigated.
  Encourage the patient to take time to reflect on the conversation.
• Reaffirm your willingness to support when the patient is ready.
• Provide referrals to other health care services.
• Offer educational material and connect to social supports and community resources.
• Follow-up. Repeat screening and brief intervention regularly.

• Schedule follow-up visits.
• At follow-up, document alcohol use and assess if the patient has been able to meet and sustain planned goals.

If the patient has met their planned goal:

• Congratulate them, and reinforce and support continued change.
• Coordinate care with referral partners if the patient has accessed additional support. With the patient’s consent, communicate with external or community agencies on the patient’s progress.
• Assess and address any comorbid medical conditions or concurrent mental health symptoms or disorders (e.g., insomnia, depression, anxiety), noting that these may improve with reduction in alcohol use.
• Encourage the patient to set new self-identified goals and schedule follow-up appointments.

If the patient has been unable to meet their planned intervention goal:

• Acknowledge that change is difficult.
• Relate drinking to problems a patient may be experiencing (e.g., health, psychological, social) as appropriate.
• If the following measures are not already being taken, consider:
  • Referring patient to external or community-based resources (e.g., peer support groups).
  • Recommending the involvement of family (if appropriate and with the patient’s consent).
  • Offering pharmacotherapy, psychosocial interventions, or both to patients with AUD.
  • Re-assessing or adjusting current treatment plan.
• Continue to assess and address any concurrent medical conditions or co-occurring mental health symptoms or disorders (e.g., insomnia, depression, anxiety), noting that these may improve with reduction in alcohol use.
  • Note: Pharmacological management of depression and anxiety is less effective while the patient continues to use alcohol.
• Schedule follow-up appointments.