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Medical-Management CounselingPatients with alcohol dependence who do not access specialty treatment for any reason can be treated in the primary care setting with pharmacotherapy and brief medical-management counseling. Medical-management counseling includes providing feedback on changes in laboratory tests, medical conditions, and other consequences to increase motivation; recommending abstinence as the safest goal while allowing the patient to work toward it; monitoring and facilitating medication adherence; and encouraging the use of mutual support groups. A large trial involving patients with alcohol dependence who had recently become abstinent showed that naltrexone with brief medical-management counseling resultedin a greater proportion of abstinence days thanwith more extensive counseling.36
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