Diabetes Standards of Care and Resources for Clinicians and Educators

Recommendations for Alcohol and Other Substance Use

Screening

• Screen for use of alcohol and other substances periodically. Use motivational interviewing when appropriate.
• Be alert for behaviors, symptoms, signs, and laboratory test results suggestive of alcohol and drug abuse.

Treatment Considerations

• Refer patients for behavioral health care and substance abuse treatment as appropriate.
• Counsel patients on the proper prevention and treatment of hypoglycemia. Medications and doses may require adjustment due to safety risks in the setting of ongoing alcohol or substance abuse.
• Advise abstinence from alcohol for women planning a pregnancy and during pregnancy.
• Advise abstinence for people with medical problems such as:
  • liver disease
  • pancreatitis
  • advanced neuropathy
  • severe hypertriglyceridemia
  • known substance abuse
  • known alcohol addiction
• For patients unwilling or unable to limit/abstain from alcohol or substance use, adjust medication choices and dosing schedules to minimize patient safety risks.
• For those who choose to use alcohol, recommend:
  • Monitoring glucose levels before and after alcohol consumption, as well as bedtime
  • Avoid drinking alcohol on an empty stomach or when glucose levels are low
  • Avoid skipping meals
  • Advising patient and their family (if possible) on the proper identification and treatment of hypoglycemic events
  • Limiting alcoholic beverages to:
    • 1 serving* per day for adult women, and
    • 2 servings per day for adult men.

*1 serving = 12 oz. beer, 5 oz. glass of wine, or 1.5 oz. distilled spirits [e.g., vodka, whiskey, gin, etc.]

Featured Alcohol and Other Substance Abuse Resources

Organization	Resource
	Alcohol and Substance Abuse Program
	National Institute on Alcohol Abuse and Alcoholism, Health Professionals and Communities Exit Disclaimer: You Are Leaving www.ihs.gov
	Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Exit Disclaimer: You Are Leaving www.ihs.gov  The Lancet 2018 Sep; 392: 1015-1035

Alcohol and Other Substance Abuse Patient Education Resources

Organization	Resource
	Drug Abuse Information Information on Alcohol and Substance Abuse Teen Drug Abuse
	National Institute on Drug Abuse Exit Disclaimer: You Are Leaving www.ihs.gov  Rethinking Drinking: Alcohol and Your Health Exit Disclaimer: You Are Leaving www.ihs.gov
	SAMHSA's National Helpline Exit Disclaimer: You Are Leaving www.ihs.gov