Step-by-Step Guide for Treating Alcohol Use Disorder

Getting Started

The following steps are based upon the 2023 Canadian Guideline for Treating High Risk Drinking and Alcohol Use Disorder*

  1. Screening, Diagnosis and Brief Intervention

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  • Routinely ask patients about alcohol consumption.

  • Use a conversational approach, and use Canada’s Guidance on Alcohol and Health as an educational resource and discussion tool in primary care practice.

  • If your patient screens for high-risk drinking, undergo a diagnostic screening using DSM-5 criteria, and take a detailed history and assessment.

  • RECOMMENDATION 1: When appropriate, clinicians should inquire about current knowledge of and offer education to adult and youth patients about Canada’s Guidance on Alcohol and Health, in order to facilitate conversations about alcohol use. (LOW, STRONG)

    RECOMMENDATION 2: All adult and youth patients should be screened routinely for alcohol use above low risk. (MODERATE, STRONG)

    RECOMMENDATION 3: All adult and youth patients who screen positive for high-risk alcohol use should undergo a diagnostic interview for AUD using the Diagnostic and statistical manual of mental disorders, 5th ed, Text Revision (DSM-5-TR) criteria and further assessment to inform a treatment plan if indicated. (LOW, STRONG)

    RECOMMENDATION 4: All patients who screen positive for high-risk alcohol use should be offered brief intervention. (MODERATE, STRONG)

    *(GRADE ratings for quality of evidence and strength of recommendation)

    More detailed information: Canadian Guidelines

  • Assessment checklist

    DSM-5 diagnostic checklist

    For more please visit: Guidelines Point of Care Tools

  • CCSA Safe Drinking One-pager

    Recognizing Alcohol Use Disorder in Self and Others

    Did You Know: About Alcohol Use Disorder

2. Withdrawal Management

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  • To determine a patient’s withdrawal symptoms, consider one of the two most-widely used tools, the CIWA-Ar or SAWS.

  • Use the Prediction of Alcohol Withdrawal Severity Scale to assess the risk of severe withdrawal complications and as a guide to creating a management plan.

  • It is important to talk to your patient about withdrawal and set them up with appropriate care, as umanaged severe withdrawal symptoms can cause serious complications.

  • Patients who complete withdrawal management should be offered ongoing care.

  • RECOMMENDATION 5: Clinicians should use clinical parameters, such as past seizures or past delirium tremens, and the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) to assess the risk of severe alcohol withdrawal complications and determine an appropriate withdrawal management pathway. (MODERATE, STRONG)

    RECOMMENDATION 6: For patients at low risk of severe complications of alcohol withdrawal (e.g., PAWSS < 4), clinicians should consider offering non-benzodiazepine medications, such as gabapentin, carbamazepine, or clonidine for withdrawal management in an outpatient setting (e.g., primary care, virtual). (Gabapentin: MODERATE, STRONG; Carbamazepine, Clonidine: LOW, STRONG)

    RECOMMENDATION 7: For patients at high risk of severe complications of withdrawal (e.g., PAWSS ≥ 4), clinicians should offer a short-term benzodiazepine prescription ideally in an inpatient setting (i.e., withdrawal management facility or hospital). However, where barriers to inpatient admission exist, benzodiazepine medications can be offered in outpatient settings if patients can be closely monitored. (HIGH, STRONG)

    RECOMMENDATION 8: All patients who complete withdrawal management should be offered ongoing AUD care. (LOW, STRONG)

    *(GRADE ratings for quality of evidence and strength of recommendation)

    More detailed information: Canadian Guidelines

  • To assess a patient’s withdrawal symptoms use either the Clinical Institute Withdrawal Assessment (CIWA-Ar) or the Short Alcohol Withdrawal Scale (SAWS).

    To predict severe withdrawal, use the online Prediction of Alcohol Withdrawal Severity Scale (PAWSS)

    For more tools: National Guidelines Point of Care Tools

  • All about Safe Withdrawal

    Understanding Alcohol Use Disorder and Treatment Options

3. Psycho-Social Treatment Interventions

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  • Become familiar with primary-care led, specialist-led and psycho-social treatment options available in your community.

  • Talk with your patient to determine what supports — whether a brief intervention, a referral to a specialist or to a community program is the best fit with their preference, identity, goals and lived experience.

  • Understand that diagnosis of AUD should not be considered a barrier to treatment for concurrent mental health disorders—both should be prioritized for treatment with evidence-based interventions. Consultation with a concurrent disorders specialist is advised where available.

4. Pharmacotherapy Options

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  • Offer evidence-based pharmacotherapy to your patients that need assistance to curb or eliminate cravings.

  • Be sure to work with your patient to set drinking goals, as abstinence is not always required or desired, and this can affect which medication should be offered.

  • Use our interactive online Medication Selection Tool to ask your patient a list of quick questions, which will then generate a list of suggested medications to try based upon their responses.

  • If a first medication doesn’t work, trial a next medication or combination of medications.

  • Please note important recommendations about NOT prescribing anti-psychotics or SSRIs to treat AUD. If you choose an SSRI for other conditions, monitor for worsening AUD symptoms.

  • Offer pharmacotherapy in conjunction with psycho-social inventions and/or community-based programs.

  • Monitor and provide follow-up care.

  • RECOMMENDATION 10: Adult patients with moderate to severe AUD should be offered naltrexone or acamprosate as a first-line pharmacotherapy to support achievement of patient-identified treatment goals.

    A. Naltrexone is recommended for patients who have a treatment goal of either abstinence or a reduction in alcohol consumption.

    B. Acamprosate is recommended for patients who have a treatment goal of abstinence.

    (HIGH, STRONG)

    RECOMMENDATION 11: Adult patients with moderate to severe AUD who do not benefitfrom, have contraindications to, or express a preference for an alternate to first-line medications can be offered topiramate or gabapentin.

    (Topiramate: MODERATE, STRONG; Gabapentin: LOW, CONDITIONAL)

    RECOMMENDATION 12: Adult and youth patients should not be prescribed antipsychotics or SSRI antidepressants for the treatment of AUD. (MODERATE, STRONG)

    RECOMMENDATION 13: Prescribing SSRI antidepressants is not recommended for adult and youth patients with AUD and a concurrent anxiety or depressive disorder. (MODERATE, STRONG)

    RECOMMENDATION 14: Benzodiazepines should not be prescribed as ongoing treatment for AUD. (HIGH, STRONG)

    *(GRADE ratings for quality of evidence and strength of recommendation)

    More info: Canadian guidelines

  • Coming soon: online interactive Medication Selection Tool

    Paper version of the Medication Selection Tool

  • Overview about using Medications for Alcohol Use Disorder

    List of Medications used to control cravings

Online Medication Selection Tool

5. Community-Based Supports and Programs

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  • Learn about local peer-support groups and community-based programs.

  • Offer information about these programs, including those for families and for specific populations such as youth, 2S/LGBTQ+ and Indigenous peoples, to your patient as fits with their identity, goals or lived experience.

  • Suggest, but don’t force, participation.

  • Check in with your patient about their experience, attendance, and overall satisfaction of suggested programs.

*Please note that the information on these pages does not constitute medical advice, nor does it override the responsibility of health care professionals to make appropriate decisions using their own judgment.

We would like to extend a special thank you to the Canadian Research Initiative on Substance Misuse (CRISM) and BC Centre on Substance Use (BCCSU), which developed the first-ever Canadian guideline for treating high-risk drinking and alcohol use disorder, published October 2023. Follow the link for the full guideline as well as detailed information on all of the above steps, 10 Principles of Care, information about working with specific populations and much more.

Browse for events, education opportunities, tools and more

  • EDUCATION OPPORTUNITIES AND EVENTS

    Are you wanting to learn more about alcohol use disorder and treatment options? Whatever your knowledge level, click to access Introductory videos, and to access presentations, podcasts and more.

  • MEDICATION SELECTION TOOL

    Do you want some help selecting medications and integrating treatment into your practice? Click here to learn more about our online medication selection tool, currently in trial phase.

  • GET INVOLVED

    Are you ready to share information about your experiences treating AUD, or do you want to converse and preview case studies with fellow clinicians? Discover the many ways you can get involved with our Society.