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DipABLM study materials
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DipABLM: Avoidance of Risky Substances

DipABLM · Work through your exam, one topic at a time.

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Avoidance of Risky Substances

Tobacco, alcohol, and other substance use are the most potent modifiable risks in lifestyle medicine. The exam tests brief intervention frameworks, first-line pharmacotherapy, and the specific thresholds and screening tools.

Tobacco

  • Use the 5 A's: Ask, Advise, Assess, Assist, Arrange. Brief advice alone raises quit rates; combining counseling with pharmacotherapy roughly doubles to triples success.
  • First-line medications: varenicline, bupropion, and nicotine replacement. Combination NRT (patch plus short-acting gum or lozenge) is more effective than a single form.
  • E-cigarettes are not first-line cessation therapy; evidence for long-term safety is incomplete.
  • Quitlines (1-800-QUIT-NOW in the US) and text programs extend counseling reach.

Alcohol

  • Screen with AUDIT-C or a single-question screen; give brief feedback and advice.
  • US guidance: no more than 2 drinks/day for men and 1/day for women; the WHO position is that no level is entirely safe because of cancer risk.
  • Alcohol use disorder treatment includes naltrexone, acamprosate, disulfiram, and behavioral therapy; abrupt withdrawal in dependent patients can be dangerous and needs medical management.

Other substances

Ask about cannabis, stimulants, opioids, and inhalants; use SBIRT (Screening, Brief Intervention, Referral to Treatment).

Worked example

A 50-year-old smokes one pack daily, has tried "cold turkey" twice, and wants to stop. Reasoning: ask and advise, then assist - set a quit date within 2 weeks, start combination NRT (patch plus lozenge), refer to the quitline, plan for withdrawal and triggers, arrange follow-up within a week. Telling him to "just quit" wastes a high-yield visit.

Traps

  • Advising cessation without offering pharmacotherapy or follow-up.
  • Accepting "cutting down" as adequate for someone with alcohol use disorder.
  • Missing vaping or cannabis because the intake form only asks about cigarettes.
  • Recommending abrupt alcohol withdrawal without assessing for dependence.
  • Treating cessation as a single conversation rather than a repeated, planned intervention.