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 Branch
	National Institute on Alcohol Abuse and Alcoholism, Health Professionals and Communities Exit Disclaimer: You Are Leaving www.ihs.gov

Alcohol and Other Substance Abuse Patient Education Resources

Organization	Resource
	Information on Drug Disorders Information for Patients on Alcohol and Substance Use Disorders Teen Drug Abuse
	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