title: Primary care management of alcohol use disorder and at-risk drinking: Part 2: counsel, prescribe, connect.
abstract: OBJECTIVE
  To provide primary care physicians with evidence-based information and advice on the management of at-risk drinking and alcohol use disorder (AUD).
  
  
  METHODS
  We conducted a nonsystematic literature review using search terms that included primary care; screening, interventions, management, and treatment; and at-risk drinking, alcohol use disorders, alcohol dependence, and alcohol abuse; as well as specific medical and counseling interventions of relevance to primary care.
  
  
  RESULTS
  For their patients with at-risk drinking and AUD, physicians should counsel and, when indicated (ie, in patients with moderate or severe AUD), prescribe and connect. Counsel: Offer all patients with at-risk drinking a brief counseling session and follow-up. Offer all patients with AUD counseling sessions and ongoing (frequent and regular) follow-up. Prescribe: Offer medications (disulfiram, naltrexone, acamprosate) to all patients with moderate or severe AUD. Connect: Encourage patients with AUD to attend counseling, day or residential treatment programs, and support groups. If indicated, refer patients to an addiction medicine physician, concurrent mental health and addiction services, or specialized trauma therapy.
  
  
  CONCLUSIONS
  Family physicians can effectively manage patients with at-risk drinking and AUD.
authors.affiliation: Staff physician with the Women's College Hospital Family Health Team in Toronto, Ont. sheryl.spithoff@wchospital.ca.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Spithoff
authors.affiliation: Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Medical Director of the Substance Use Service at Women's College Hospital.
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
mesh_terms: D000428:Alcohol Drinking; D019973:Alcohol-Related Disorders / Q000628:therapy*; D002170:Canada; D003376:Counseling; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*