Aims: To analyze the current paradigm and clinical practice for dealing with alcohol use disorders
(AUD) in primary health care.
Methods: Analyses of guidelines and recommendations, reviews and meta-analyses.
Results: Many recommendations or guidelines for interventions for peoplewith alcohol use problems
in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle:
screening for alcohol use and alcohol-related problems, brief interventions for hazardous and in
some cases harmful drinking, referral to specialized treatment for people with AUD. However, while
there is some evidence that these procedures are effective in reducing drinking levels, they are rarely
applied in clinical practice in primary health care, and no interventions are initiated, even if the primary
care physician had detected problems or AUD. Rather than asking primary health care physicians to
conduct interventions which are not typical for medical doctors, we recommend treatment initiation
for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular
checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding
thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful.
Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity
with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders).
