Immediate follow up and subsequent treatments following alcohol withdrawal will usually be carried out by specialists in secondary care; if this has not occurred it is important to offer support in the primary care setting.

• Offer advice, reassurance, and treatment.
• Counselling should be continued for as long as necessary.
• People who are dependent on alcohol often require long-term counselling by specialists (intensive treatment, not usually available in primary care).
• Acamprosate may be useful as an adjuvant to counselling. Although it is usually initiated in specialist settings, acamprosate is often continued in primary care for up to a year, and can be initiated by GPs if necessary.
• The effectiveness of ongoing maintenance with acamprosate should be monitored by the primary care team.
• If a specialist service is not available or is not being used, consider initiating acamprosate in primary care (with continued counselling).
• For details on prescribing, see the section on Acamprosate in Prescribing information.
• Self-help manuals and mutual-aid groups (for example Alcoholics Anonymous) may benefit some people.
• Self-help manuals should be based on cognitive behavioural principles. They should be used as an adjunct to other treatments in people with mild or moderate alcohol dependence, not as a replacement for treatment.
• Alcoholics Anonymous operates on the premise that alcoholism is a disease, and its goal is abstinence. There is a strong spiritual aspect which is not suitable for everyone, and people should not be coerced to attend meetings. See www.alcoholics-anonymous.org.uk.
• A popular alternative mutual-aid group in the UK is SMART Recovery^® (Self Management and Recovery Training); see www.smartrecovery.org.uk.
• Naltrexone and disulfiram (Antabuse^®) are options that should only be considered in secondary care.
• Maintain contact with people over the long term, and offer appropriate treatment if relapse occurs. Once maintenance has been established and a person has been released from specialist care, it is important to maintain contact in primary care, for a period of at least 3 years:
• Contact should be maintained using low-intensity monitoring. This may be done by telephone or brief appointment.
• If possible, there should be a continuity of care, with the same healthcare professional maintaining contact with the person.
• If relapse occurs, help should be offered immediately.