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  • The Review Course in Family Medicine

GUIDELINE ALERT: New Canadian high-risk drinking guidelines

Simple web-based tools and algorithms to help you at the bedside

by Dr Simon Moore MD CCFP FCFP

Though you may have been trained to “ask, advise, assess, assist, arrange” when it comes to addictions,

there has been little standardized guidance on what to do next when your patient says “yes, I drink too


This week, CMAJ published national guidelines on clinical management of high-risk drinking and alcohol

use disorder, and it comes with a stunning and useful website jammed full of simple, straightforward,

evidence-based tools and algorithms.

Now you can provide guideline-based answers for your next vSOO or SAMP, or more importantly, for the next patient you meet who is at risk. Here’s what you need to know.

1. There’s a helpful website included with the guideline:

This is a one-stop shop for patients, people concerned about a loved one, and a quick-reference

section that covers the guideline recommendations for healthcare providers

2. Screening is simple with a single question…

“How many times in the past year have you had 5 or more drinks in a day (for males) or 4 or

more drinks in a day (for females)?”

3. …and the guideline provides a simple checklist for what to do if they say yes

For moderate risk, there are tips on exactly what to say for a brief intervention. For high risk see the section on diagnosing using DSM-5 criteria, lab tests, and treatment using non-pharmacologic options and naltrexone or acomprosate (and what to avoid including SSRIs, antipsychotics)

4. Withdrawal management tips are included as well

See the brilliant withdrawal management pathway for steps on assessing withdrawal risk using

PAWSS* and prescribing gabapentin or clonidine if low risk, and inpatient short-course

benzodiazepines if high risk

*Prediction of Alcohol Withdrawal Severity Scale

Source: CMAJ October 16, 2023 195 (40) E1364-E1379



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