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Continuing CareUp to three quarters of patients have a relapse in the year after alcohol-use treatment. Relapse risks are highest during the first 3 months of sobriety and around the 1-year anniversary. Specialty “aftercare” offers low-intensity, longitudinalmanagement that includes ongoing relapse prevention counseling and monitoring for relapse, but dropout is common. Generalist clinicians should also deliver continuing care. The clinician should emphasize that care is not contingent on abstinence and should inquire at regular visits in a nonjudgmental manner about progress toward functional and treatment goals, medication adherence, attendance at specialty aftercare and mutual support groups, alcohol consumption, craving, triggers, and coping strategies. Randomizedtrials have suggested that providingfeedback regarding objective health improvements(e.g., graphing baseline and serial serumγ-glutamyltransferase levels and reviewing theplot with the patient) can reduce drinking andpossibly mortality.46,47 Alcohol biomarkers maybe useful as motivational tools and indicators ofrelapse. Randomized studies have shown thatsupportive telephone monitoring and brief counselingcan reduce recurrent drinking.48
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