New Australian guidelines for the treatment of alcohol problems: an overview of recommendations

Abstract

Screening and assessment (Chapter 2): screening techniques to identify patients with alcohol problems, and subsequent assessments for clinicians to undertake before providing specific treatments or interventions.• Interventions, treatments, relapse prevention and aftercare (Chapter 3): a range of varying interventions and treatments, including brief interventions, brief e-health interventions, psychosocial interventions, alcohol withdrawal management, pharmacotherapy options, and peer support programs. In the final section of this chapter, relapse prevention, aftercare, and long term follow-up strategies are discussed.• Considerations for specific populations (Chapter 4): the management of alcohol problems and treatment considerations for specific population groups of interest in Australia -genderspecific considerations, adolescents and young people, pregnant and breastfeeding women, Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups, sexually diverse and gender diverse populations, older people, and cognitively impaired people.• Understanding comorbidities (Chapter 5): the importance of considering a range of comorbidities when providing treatment for alcohol problems. Polydrug use, comorbid mental disorders, and physical-related comorbidities are discussed.The content of this supplement is based on the various chapters of the full Guidelines for the Treatment of Alcohol Problems, which were based on reviews of the evidence, including well designed meta-analyses and randomised controlled trials, wherever possible. Where this evidence was not available, recommendations were based on the best available research or clinical experience. Each recommendation in the guidelines is accompanied with a level of evidence based on National Health and Medical Research Council evidence recommendations (Box 2), 21 with "A" representing the most evidence and "GPP" (good practice point) indicating a recommendation with no evidence.For more on the Guidelines for the Treatment of Alcohol Problems, visit https://alcoh oltre atmen tguid elines.com.au/. Acknowledgements:The Guidelines for the Treatment of Alcohol Problems project was funded by the Australian Government, under the Drug and Alcohol Program. We would like to express our gratitude to members of the Guidelines Steering Committee for providing invaluable guidance and advice on this project. We thank Daniel Winter, Sophia Little, Brennan Geiger and James Pham for providing research and administrative support, and Joshua Watt for providing clinical support, across sections of this supplement. Finally, we thank Donna Ah Chee, Kylie Lee, Teagan Weatherall, Craig Holloway and Martin Nean for conversations and work which informed the Aboriginal and Torres Strait Islander peoples section in the guidelines and Chapter 4 of this supplement.Competing interests: Paul Haber has been funded by the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney to undertake clinical trials of cannabinoid treatment for alcohol withdra...

Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches

“…The patient’s perception of the importance and/or moral obligation in providing more accurate information for research purposes may also lead to differences between clinic and research estimates. Current tools used for the assessment of PAE in Australian antenatal care include the AUDIT-C, T-ACE, and TWEAK, as mentioned in the current clinical guidelines [ 176 ]. The use of AUDIT-C in clinical practice is likely particularly useful, and its application advocated.…”

More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments

“…In many ACCHSs, Aboriginal Health Practitioners and nurses regularly perform preventative health assessments [ 42 ] and develop individualised care plans. Some screening using evidence-based tools could also be completed prior to consultation by the clients themselves in the waiting room using computer-based, visual, interactive surveys [ 33 , 43 , 44 ] which could also include brief interventions [ 45 ]. But fully automated tools might not be suitable for Indigenous Australian clients with lower computer literacy, or those who would feel more comfortable receiving less direct feedback delivered by clinicians in conversation.…”

“…Some Indigenous Australians might also find direct questioning based on AUDIT-C items intrusive [ 33 ]. For these situations clinicians may need to adapt AUDIT-C phrasing as needed [ 49 ], or to obtain the relevant information through conversational approaches [ 45 ]. If the basic AUDIT-C content is covered (which establishes the quantity and frequency of regular consumption, and the frequency of heavy drinking occasions), we would expect these assessments to still be effective in establishing drinking risk.…”

Alcohol Withdrawal Is an Oxidative Stress Challenge for the Brain: Does It Pave the Way toward Severe Alcohol-Related Cognitive Impairment?

“…AW is still considered as a dangerous complication of undetected AUD during any surgery or medical inpatient treatment [ 14 ]. Milder forms of AW may also be observed during scheduled alcohol cessation, but it is easily preventable or treatable in ambulatory practice [ 15 , 16 , 17 ].…”