Supporting Patients with Alcohol Use Disorder: From Assessment to Relapse Prevention

Alcohol use disorder (AUD) affects millions of Australians but often goes undiagnosed in primary care. At Meducate’s recent Alcohol Masterclass, three leading experts Dr Richard Bradlow, Dr Anna Cunningham and Dr Ferghal Armstrong shared evidence-based strategies for managing alcohol-related issues in general practice.

From identifying hazardous drinking to navigating withdrawal and supporting long-term recovery, this article provides a practical, clinician-focused guide to alcohol use disorder in general practice.

Step 1: Identifying Hazardous Drinking

Many patients at risk of alcohol harm do not meet criteria for dependence yet still face significant health consequences. According to the AIHW (2024), 21% of Australians aged 14+ exceed NHMRC guidelines, but only a quarter recognise their drinking as risky.

Clinical Tips:

Use AUDIT-C or full AUDIT to screen for hazardous drinking.
Ask about functional impact on work, relationships, and parenting.
Screen for underlying causes such as depression, PTSD, or sleep disorders.
Assess motivation to change using a 0–10 scale.

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Consider cognitive assessment for Wernicke’s encephalopathy.
Conduct physical health checks: LFTs, ECG, and nutritional status.

SBIRT (Screen, Brief Intervention, and Referral to Treatment) remains a powerful, quick tool in primary care.

Step 2: Managing Alcohol Withdrawal Safely

Dr Anna Cunningham outlined the clinical decision-making process for community vs inpatient detox, highlighting key risk factors and treatment protocols.

Key Points:

Use DSM-5 or ICD-11 criteria to determine AUD severity.
Apply CIWA-Ar and PAWSS to monitor withdrawal symptoms.
Provide thiamine prophylaxis early to prevent Wernicke’s encephalopathy.
Implement structured benzodiazepine tapering protocols in outpatient settings.
Ensure daily monitoring, safety planning, and staged dispensing.

Outpatient detox can be safe for selected patients but “there are no heroes in community detox”—always know when to escalate.

Step 3: Preventing Relapse Through Systems and Support

Dr Ferghal Armstrong explored the psychology of relapse prevention, integrating motivational interviewing, habit loop theory and pharmacological options.

Non-Pharmacological Strategies:

Use positive goals and habit tracking (e.g. journals, star charts).
Promote accountability and peer support.
Address early warning signs: isolation, shame, “just one” thinking.
Leverage positive psychology: gratitude, social connection, meaningful activity.

Relapse Prevention Medications:

Medication	Use	Precautions	Side Effects
Naltrexone	Reduces craving; suitable for controlled drinking	Avoid in liver disease	Nausea, headache
Acamprosate	Supports abstinence	Avoid in renal disease	Diarrhoea, rash
Disulfiram	Aversive therapy	Avoid in IHD, pregnancy, liver disease	Severe reactions with alcohol
Baclofen	Off-label; useful in liver impairment	Sedation, seizures	Use cautiously
Topiramate	Reduces cravings	Psychiatric and renal risks	Confusion, mood changes

“The opposite of addiction is not abstinence—it’s connection.”.

Referral Pathways for Support

If withdrawal risk is high or complexity exceeds general practice scope, refer promptly:

DACAS (1800 812 804) – 24/7 clinical advice
DirectLine (1800 888 236) – Patient counselling and detox services
Turning Point – Assessment and clinical guidelines
Ready2Change – Free phone-based behaviour change program

Takeaway Summary

Step	Focus	Action
1. Identify	Hazardous drinking	Use AUDIT-C, assess risk and impact
2. Withdraw	Detox safely	Stratify risk, apply thiamine + CIWA
3. Prevent Relapse	Maintain recovery	Use goals, medications, and social connection

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🎧 Listen & Learn on the Go

Cracking Addiction Podcast
Hosted by Addiction Medicine Specialist Dr Ferghal Armstrong, this series explores topics like substance use, relapse prevention, dopamine regulation, and food addiction.

Available on:
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🔗 YouTube Playlist