Harmful or hazardous use of alcohol without severe dependence can sometimes revert to risk-free drinking. Patients with social supports (family and job) and without impulsive personalities and many social problems are most likely to succeed. For others, including most of those dependent on alcohol, the goal of abstinence is better. In patients attending specialized outpatient clinics, the proportion who can sustain problem-free drinking for at least 1 year is small—5 per cent is a typical findingA.7.,! and 19) A randomized trial comparing the goals of controlled drinking and abstinence did not favour controlled drinking. (20> However, for patients without established dependence, reduction programmes (whether or not towards abstinence) using FRAMES (Tib.!§,,,2.) proved to be more effective than no intervention.^2 22 and 23 Interventions in primary care are discussed in Ch,a,p!e.L,4.;.2...2.:.5,.
Table 2 FRAMES: ingredients of a brief intervention
If controlled drinking is the agreed goal, the patient and physician collaborate to monitor the amount and pattern of the drinking as follows.
1. Limit number of days of drinking and number of drinks on any occasion.
2. Slow the rate of drinking, and/or reduce alcoholic strength of drinks.
3. Develop assertiveness skills for refusing drinks.
4. Design reward system when goals are achieved.
5. Develop awareness of triggers to overdrinking.
6. Practise other ways of coping with triggers.
7. Record pattern and amount of drinking, for example in a diary.
8. Physician and patient monitor g-glutamyl transferase blood test results.
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