Patients with at-risk drinking may benefit from brief intervention, reducing their alcohol use substantially or initiating abstinence. A minority of these patients will continue to progress in their use of alcohol, eventually meeting criteria for alcohol use disorder.[124]Grant BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiological Survey. J Stud Alcohol. 1997 Sep;58(5):464-73.
http://www.ncbi.nlm.nih.gov/pubmed/9273910?tool=bestpractice.com
Alcohol use disorder tends to run a chronic course. While treatment does impact the condition positively, return to use is common, particularly in the first 12 months after treatment initiation.[3]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.[125]Finney JW, Hahn AC, Moos RH. The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects. Addiction. 1996 Dec;91(12):1773-96.
http://www.ncbi.nlm.nih.gov/pubmed/8997760?tool=bestpractice.com
Nonetheless, many patients will successfully reduce or stop their drinking, often without clinician support. There are many opportunities for clinicians to prevent harms from alcohol use. Medication treatments are underutilized for alcohol use disorders, despite their efficacy.[126]Williams SH. Medications for treating alcohol dependence. Am Fam Physician. 2005 Nov 1;72(9):1775-80.
http://www.aafp.org/afp/20051101/1775.html
http://www.ncbi.nlm.nih.gov/pubmed/16300039?tool=bestpractice.com
Treatment that combines the use of psychosocial interventions with pharmacotherapy can improve outcomes for those with alcohol use disorder, versus single-modality treatment.[61]Ray LA, Meredith LR, Kiluk BD, et al. Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA Netw Open. 2020 Jun 1;3(6):e208279.
https://www.doi.org/10.1001/jamanetworkopen.2020.8279
http://www.ncbi.nlm.nih.gov/pubmed/32558914?tool=bestpractice.com
[62]Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: a review. JAMA. 2018 Aug 28;320(8):815-24.
http://www.ncbi.nlm.nih.gov/pubmed/30167705?tool=bestpractice.com