Guideline 74: The management of harmful drinking and alcohol dependence in primary care

The management of harmful drinking and alcohol dependence in primary care
Section 6: Advising families

The drinker’s family may seek advice on how they should intervene when the drinker is not motivated to change. “Detaching with love” (one of the principles by which Al-Anon members lessen the risk of harm to their own mental health resulting from living with a drinker), or simple confrontation, are less likely to get the drinker to change or seek help than using an approach based on community reinforcement and family training (CRAFT).^{153,
154} Although not tested in primary care, the method can be taught to non-specialists. Evidence level 1+

CRAFT instructs the family or “committed significant other” to reinforce, by encouragement or other rewards, any changes or statements that the drinker makes towards stopping or reducing the drinking, and to do nothing to enable or reward drinking. The treating team lays down the groundwork for rapid availability of outpatient treatment for the drinker in the event that he or she opts to begin therapy. The family are prepared from the beginning to recognise and respond safely to any potential for domestic violence during the introduction of what may be a new way of reacting to the drinker and the drinking.

The family are helped to:

understand the nature of alcohol dependence
improve communication with the drinker
selectively apply or withdraw reinforcement, to amplify non-drinking
apply pressure without bickering or recrimination
learn stress reduction and gain more reward in their own life
use effective methods and optimal times for proposing treatment entry to the drinker, such as restricting key messages to moments of sobriety, and exploiting alcohol related crises
support the drinker through treatment.

The following recommendation has been extrapolated from the above trials.

The primary care team should help family members to use behavioural methods which will reinforce reduction of drinking and increase the likelihood that the drinker will seek help.