Counseling patients on the risks and benefits of ‘Dry January’

Over the past decade, a growing number of people in the US and UK have greeted the New Year with a month-long respite from alcohol. Under the tradition known as Dry January, participants put down the bottle and take a break from boozing.

For physicians, Dry January is an opportunity to discuss alcohol intake. However, despite the widespread benefits of not drinking for most people, stopping suddenly could put heavy drinkers at risk for dangerous withdrawals. 

Earn buy-in with motivational interviewing

Although it’s common to exceed the recommended limits for alcohol, not everyone is ready to cut back. Before making suggestions or offering unsolicited advice, physicians should start with motivational interviewing techniques to effectively reach patients who are on the fence about change. 

An effective counseling session can start with a brief conversation.^[] While you’ll need to tailor your approach to the patient’s readiness level, some general questions include:

• How would you like to change your relationship with alcohol?

• What benefits do you think you’d experience from taking a break from drinking?

• What are the downsides of continuing your current level of drinking?

These questions can help elicit “change talk,” which you can then reinforce by affirming statements that support positive changes. For instance, if the patient says, “A break from drinking would probably help me lose weight and save money,” you can respond by saying, “It’s possible that your health and finances would improve if you didn’t drink.” 

As patients show more interest and willingness to change, you can steer the conversation to education and goal-setting.

Successful teetotaling tips

A study cited by Harvard Health Publishing found that by avoiding alcohol for 1 month, abstainers experienced better sleep, more energy, weight loss, reduced cancer-related blood proteins, and lower blood pressure and cholesterol levels.^[]

Encourage patients to explore the National Institute on Alcohol Abuse and Alcoholism’s website, Rethinking Drinking, as a helpful resource with tools to cut back.^[] Providers may also help patients by setting up support groups for Dry January in the office or online. For accountability, refer patients to apps like the Try Dry app, which shows how much money and calories are saved each day by not drinking. 

Some things that patients can do to increase their success include modifying their environment for Dry January, and removing alcohol from the house or considering non-alcoholic substitute drinks. 

Precautions to keep in mind

If someone drinks regularly and suddenly stops, they may experience withdrawal symptoms. These can range from shaky hands to life-threatening effects. In severe withdrawal, dysfunction of the autonomic system and alteration in vital signs lead to delirium tremens, where patients experience sweating, agitation, hyperthermia, hallucinations, tachycardia, and hypertension.^[] These symptoms can last a week or longer.

HCPs should educate patients on the signs and symptoms of severe alcohol withdrawal so they know when to seek medical attention.

Long-acting benzodiazepines are commonly recommended to treat severe withdrawals. Depending on the patient’s comorbidities and social support, medical monitoring in an inpatient or outpatient setting may be recommended. Ultimately, these patients should be connected to a social worker or long-term treatment program.