Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder British Columbia Centre on Substance Use (BCCSU), B.C. Ministry of Health and B.C. Ministry of Mental Health and Addictions. Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder. 2019. Vancouver, B.C.: BCCSU. Available at: https://www.bccsu.ca/clinical-care-guidance/. Author: British Columbia Centre on Substance Use (BCCSU) Publisher: British Columbia Centre on Substance Use (BCCSU) Document Purpose: Clinical guidance Publication Date: December 2019 Target Audience: Physicians, nurses and nurse practitioners, pharmacists, allied health care professionals, and all other clinical and non-clinical personnel with and without specialized training in addiction medicine, who are involved in the care and management of individuals, families, and communities affected by alcohol use. Contact: British Columbia Centre on Substance Use 400-1045 Howe Street, Vancouver, BC V6Z 2A9 [email protected] Land Acknowledgement The British Columbia Centre on Substance Use would like to respectfully acknowledge that the land on which we work is the unceded territory of the Coast Salish Peoples, including the territories of the xwmeθkwey’em (Musqueam), Skwxwú7mesh (Squamish), and sel’ílweta| (Tsleil-Waututh) Nations. About the BC Centre on Substance Use e BC Centre on Substance Use (BCCSU) is a provincially networked organization with a mandate to develop, help implement, and evaluate evidence-based approaches to substance use and addiction. e BCCSU seeks to improve the integration of best practices and care across the continuum of substance use through the collaborative development of evidence-based policies, guidelines, and standards. With the support of the Province of BC, the BCCSU aims to transform substance use policies and care by translating research into education and care guidance, thereby serving all British Columbians. e BCCSU seeks to achieve these goals through integrated activities of its three core functions: research and evaluation, education and training, and clinical care guidance. Research and Evaluation — Leading an innovative multidisciplinary program of research, monitoring, evaluation and quality improvement activities to guide health system improvements in the area of substance use. Education and Training — Strengthening addiction medicine education activities across disciplines, academic institutions, and health authorities, and training the next generation of interdisciplinary leaders in addiction medicine. Clinical Care Guidance — Developing and helping implement evidence-based clinical practice guidelines, treatment pathways, and other practice support documents. About the Canadian Research Initiative in Substance Misuse e Canadian Research Initiative in Substance Misuse (CRISM) is a national research consortium uniquely focused on translational and implementation research targeting substance use and related harms, funded by the Canadian Institutes of Health Research (CIHR). e CRISM network comprises four regional Research Nodes: British Columbia, the Prairie Provinces, Ontario, and Quebec/Maritimes. e British Columbia CRISM Node is an expert network with over members spanning the province, including knowledge users, service providers, community leaders, and research scientists. All members are rmly committed to translating the best scientic evidence into practice and policy change, promoting evidence-based approaches to addiction, and training the next generation of leaders through our comprehensive education programs. 1 Authors and Contributors Emily Wagner, MSc, Senior Medical Writer, British Columbia Centre on Substance Use Maryam Babaei, MSc, Medical Writer, British Columbia Centre on Substance Use Provincial Alcohol Use Disorder Treatment Guideline Committee* Keith Ahamad (committee co-chair), MD, CCFP(AM), CISAM, Dip. ABAM; Medical Director, Regional Addiction Program, Vancouver Coastal Health; Clinical Assistant Professor, University of British Columbia; Clinician Scientist, BC Centre on Substance Use Neal Berger, PhD; Executive Director, Cedars at Cobble Hill (ret.) Rupinder Brar, MD, CCFP(AM), CSIAM; Clinical Assistant Professor, Department of Family Practice, UBC; Interim- Lead, St. Paul’s Hospital Addiction Medicine Consult Service; Physician, PHS Community Services Society Jennifer Cottell, Member, BCCSU Family Members and Caregivers Representatives Committee Nicole Cowan, RN, BSN; Clinical Educator, Vancouver Coastal Health Stephan Ferreira, MD, FASAM, FCFP; Physician, Northern Health Lyn Firth, Member, BCCSU Network of Family Members and Caregivers Robert Fox, MD, CCFP, CISAM; Sta Physician, Seabird Island Health Centre; Consulting Physician, Riverstone Outpatient Detox Program, Fraser Health Authority; Consulting Physician, A:yelexw Recovery Home Brittany Graham, MPH; Program Coordinator, Eastside Illicit Drinkers Group for Education (EIDGE); Community Developer, Vancouver Area Network of Drug Users (VANDU) Je Harries, MD, MBA; Physician Lead, South Okanagan AUD Initiative Ramm Hering, MD, MSc, CCFP, Dip. PH, Dip. ABAM, CCSAM, FASAM; Medical Director, Addiction Medicine, Island Health; Physician Lead, Victoria Rapid Access Addiction Clinic (RAAC), Island Health; Physician Lead, Addiction Medicine Consult Service (AMCS), Royal Jubilee and Victoria General Hospitals, Island Health; Victoria Site Director, BC Centre on Substance Use Addiction Medicine Fellowship; Clinical Instructor, Faculty of Medicine, University of British Columbia Ronald Joe, MSc, MBChB, DABAM; Medical Director, Substance Use, Vancouver Community, Vancouver Coastal Health Cheyenne Johnson (steering committee chair), RN, MPH, CCRP; Interim Executive Director, British Columbia Centre on Substance Use Jan Klimas, PhD, MSc; Senior Postdoctoral Fellow, BC Centre on Substance Use Ron Kuhlke, Advocate, Single Room Occupancy (SRO) Collective; Steering Committee Member, EIDGE; Board Member, VANDU Mona Kwong, BSc (Pharm), MSc, PharmD; Pharmacy Advisor, BC Centre on Substance Use; Clinical Pharmacist and Manager, Pharmasave Howe Street; Clinical Consultant Pharmacist, Innity Medical Specialists Clinic; Clinical Instructor, Faculty of Pharmaceutical Sciences, University of British Columbia Prabh Lail, MD, FRCPC, ISAM(C); Physician, St Paul’s Hospital; Fellow, Canadian Addiction Medicine Research Fellowship; Medical Director, Addiction Recovery and Community Health, Calgary, Alberta Health Services Leslie Lappalainen, MD, CCFP, Dip. ABAM; Medical Lead for Addiction Medicine, Interior Health Sandra Lee, MD, CCFP, FCFP; Medical Consultant, Guidelines and Protocols Advisory Committee; Family Physician; Assistant Clinical Professor, Department of Family Practice, University of British Columbia Mary Marlow, BHSc, RPN; Manager, Mental Health and Substance Use Services, Vancouver Community, Vancouver Coastal Health; Clinical Instructor, Vancouver Community College 2 Nick Mathew, MD, MSc, ABPN, FRCPC, ABPM; Addiction Division Lead, Surrey Memorial Hospital; Clinical Assistant Professor, University of British Columbia Mark McLean, MD, MSc, FRCPC, CISAM, Dip. ABAM; Medical Lead, St Paul’s Hospital Rapid Access Addiction Clinic; Physician, St Paul’s Hospital Addiction Medicine Consult Team; Medical Lead, Vancouver Detox, Vancouver Coastal Health; Clinical Assistant Professor, University of British Columbia Doug McTaggart, BComm, MD; Medical Consultant, Guidelines and Protocols Advisory Committee; Family Physician Jill Murray, PhD, Research Ocer; Guidelines and Protocols Advisory Committee; Ministry of Health Seonaid Nolan, MD, FRCPC, Dip. ABAM; Assistant Professor, Department of Medicine, University of British Columbia; Head, Interdepartmental Division of Addiction Medicine, Providence Health Care; Physician Program Director, Interdisciplinary Substance Use Program, Providence Health Care; Research Scientist, BC Centre on Substance Use; Health Professional Investigator, Michael Smith Foundation for Health Research Health Walton Pang, BSc (Pharm), MSc (Pharm), MHA; Director, Optimal Use, Drug Intelligence, Optimization, Outcomes, and Strategy, Pharmaceutical Services Division, Ministry of Health Daniel Paré, MD, CCFP(AM), CCSAM, Dip. ABAM; Medical Manager, Downtown Eastside (DTES) Primary Care; Medical Coordinator, DTES Connections Clinic, Vancouver Coastal Health; Clinical Instructor, Department of Family Practice, University of British Columbia Bernadette (Bernie) Pauly, RN, PhD; Professor, School of Nursing, University of Victoria; Scientist, Canadian Institute for Substance Use Research; Community Engaged Scholar, University of Victoria; Island Health Scholar in Residence Brenda Plant, BA, CSAC, CSAPA, CACCF, ICCAC, ICADC; Executive Director, Turning Point Recovery Society; Member, BC Council for Recovery Excellence Nancy Poole, PhD; Director, Centre of Excellence for Women’s Health Nitasha Puri, MD, CCFP(AM), Dip. ABAM; Physician Consultant, Vancouver Coastal Health and Fraser Health Authority; Clinical Assistant Professor, University of British Columbia; Clinician Researcher, British Columbia Centre on Substance Use Kaye Robinson, MSW, RSW; Social Worker, Rapid Access Addiction Clinic, Providence Health Care Diane Rothon, BSc, MD, CM, MPH, CFPC(AM); Medical Director, Youth Justice and Forensic Services, Ministry of Children and Family Development; Medical Director, Alavida Addiction Services Nader Shari, BSc, MD, CCFP(AM),