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Continuing Care
Up 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, longitudinal
management 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. Randomized trials have suggested that providing feedback regarding objective health improvements (e.g., graphing baseline and serial serum γ-glutamyltransferase levels and reviewing the plot with the patient) can reduce drinking and possibly mortality. Alcohol biomarkers may be useful as motivational tools and indicators of relapse. Randomized studies have shown that supportive telephone monitoring and brief counseling can reduce recurrent drinking.
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