Treating Alcohol Use Disorder: Whole-Patient Approach and Evidence-Based Strategies

In a conversation with Psychiatric Times, Joseph Volpicelli, MD, PhD, shared some tips on initiating treatment strategies for alcohol use disorder (AUD) and how to adopt a whole patient approach.

Volpicelli said it is important to understand how alcohol is impacting your patient’s life. “Alcohol can affect a person in a variety of ways. It can affect your psychology, it increases anxiety, it increases depression. It interferes with social relationships, it interferes with being able to be productive at work,” Volpicelli said. On top of that, drinking can impact and individual’s health physically, including liver function.

Understanding how a patient feels about their addiction is important to work collaboratively. “You can come together and set goals, which are important for the person that you are working with. You get a sense of what the person’s needs are and what their goals are, why they want to get better,” Volpicelli said. An alliance with the patient increases their chances of adhering to treatment.

Knowing all of the evidence-based treatments is important when treating AUD. Volpicelli said he thinks naltrexone is the gold standard for medications, but psychosocial support for patients in treatment can help patients engage in treatment and address other issues impacting them.

“Some people are going to be really good with adhering them, and other people are going to be on the fence, they’re not sure if they really want to give up their drinking or they’re ambivalent,” Volpicelli said of patients in treatment. He said it is important for clinicians not to be discouraged when that happens, and that these are opportunities to show patients how doing something about their drinking is in their best long term interest.

“Meet people where they are,” Volpicelli said, adding to expect incremental improvement over time instead of immediate improvement. Labeling alcohol addiction in patients isn’t important to Volpicelli, considering the interrelationship between stress, anxiety and depression that it is difficult to disentangle them and work with them separately. 

This is part 2 of a 6-part interview with Joseph Volpicelli, MD, PhD. You can watch the full interview here.

Dr Volpicelli is the executive director of the Institute of Addiction Medicine.