Alcohol and API

1. APA recommends (1C) that the initial psychiatric evaluation of a patient with suspected alcohol use disorder include assessment of current and past use of tobacco and alcohol as well as any misuse of other substances, including prescribed or over-the-counter medications or supplements.

2. APA recommends (1C) that the initial psychiatric evaluation of a patient with suspected alcohol use disorder include a quantitative behavioral measure to detect the presence of alcohol misuse and as- sess its severity.

3. APA suggests (2C) that physiological biomarkers be used to identify persistently elevated levels of alcohol consumption as part of the initial evaluation of patients with alcohol use disorder or in the treatment of individuals who have an indication for ongoing monitoring of their alcohol use.

4. APA recommends (1C) that patients be assessed for co-occurring conditions (including substance use disorders, other psychiatric disorders, and other medical disorders) that may influence the selec- tion of pharmacotherapy for alcohol use disorder.

5. APA suggests (2C) that the initial goals of treatment of alcohol use disorder (e.g., abstinence from alcohol use, reduction or moderation of alcohol use, other elements of harm reduction) be agreed on between the patient and clinician and that this agreement be documented in the medical record.

6. APA suggests (2C) that the initial goals of treatment of alcohol use disorder include discussion of the patient’s legal obligations (e.g., abstinence from alcohol use, monitoring of abstinence) and that this discussion be documented in the medical record.

7. APA suggests (2C) that the initial goals of treatment of alcohol use disorder include discussion of risks to self (e.g., physical health, occupational functioning, legal involvement) and others (e.g., im- paired driving) from continued use of alcohol and that this discussion be documented in the med- ical record.

8. APA recommends (1C) that patients with alcohol use disorder have a documented comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and phar- macological treatments.

Selection of a Pharmacotherapy

9. APA recommends (1B) that naltrexone or acamprosate be offered to patients with moderate to severe alcohol use disorder who
• haveagoalofreducingalcoholconsumptionorachievingabstinence,
• preferpharmacotherapyorhavenotrespondedtononpharmacologicaltreatmentsalone,and • havenocontraindicationstotheuseofthesemedications.

10. APA suggests (2C) that disulfiram be offered to patients with moderate to severe alcohol use disor- der who
• haveagoalofachievingabstinence,
• preferdisulfiramorareintoleranttoorhavenotrespondedtonaltrexoneandacamprosate, • arecapableofunderstandingtherisksofalcoholconsumptionwhiletakingdisulfiram,and • havenocontraindicationstotheuseofthismedication.

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