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Friends and relatives of individuals who abuse alcohol may often feel compelled to approach the person and discuss how that person’s alcohol abuse is affecting everyone around them. When viewing the actions of an individual with a substance use disorder from the outside, it is often clear that the person’s actions are problematic and self-destructive; however, the subjective view of the person with a substance use disorder is that their actions are “normal” for them and do not represent an issue. The difference between the objective viewpoint of outsiders and the subjective viewpoint of the individual with the alcohol use disorder often results in a reaction to both sides that leads to frustration, resentment, and confusion for both parties.

When an individual’s alcohol abuse is affecting others around them , close friends and family members of that person do not have to sit by idly. A proactive approach to pointing out the individual’s behavior and getting them to do something about it can be accomplished. Often, the best way to approach an individual about their problematic alcohol use is to organize an alcohol abuse intervention for the person.

The Alcohol Abuse Intervention

In the current context the term refers to a structured and organized attempt by family and friends of an individual with a substance use disorder to point out the dysfunctional and destructive aspects of that individual’s behavior and convince the person to get into treatment. Because many individuals with alcohol use disorders are not able to view their behaviors objectively, using an alcohol abuse intervention allows the person to be exposed to numerous points of view regarding their alcohol abuse.

The utility of an intervention lies in the ability of the participants to appeal to the strength of the individual’s bonds with family members and close friends, get them outside of their own subjective and selfish motives, and look at their behavior as individuals close to them view it. Because there is strength in numbers, the intervention can work by removing the person with the alcohol use disorder from their own subjective viewpoint, addressing their issues with reluctance and denial, and implementing undesirable consequences if the person continues to abuse alcohol and decides not to enter treatment.

A sure way to reduce the effectiveness of an alcohol abuse intervention is to approach it in a manner that will automatically increase resistance and defensiveness in the individual with the alcohol use disorder. There are certain things to avoid when considering an intervention, such as:

There are several approaches to substance abuse interventions (see below); however, there are some general commonalities that apply to different intervention models . These models will typically begin with planning sessions, rehearsals, performing the actual intervention, and then following up on the effects/outcome of the intervention. Interventions can be performed without professional help, but this is not advisable.


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ADA = American Diabetes Association .

Adapted with permission from Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists . Diabetes Care. 2008;31(8):1684 .

ADA = American Diabetes Association .

Adapted with permission from Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists . Diabetes Care. 2008;31(8):1684 .

Data Sources: A PubMed search was completed in Clinical Queries using the terms diabetic, foot, and infections. The search included meta-analyses, randomized controlled trials, clinical trials, reviews, expert opinions, and guidelines. We also searched the Cochrane database, Clinical Evidence, and Essential Evidence Plus. Search dates: February 1, 2012, to November 30, 2012.

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FASSIL W. GEMECHU, MD, is a staff physician and assistant professor in the Department of Family Medicine at MetroHealth Medical Center in Cleveland, Ohio. ...

FNU SEEMANT, MD, is a fellow in primary care sports medicine in the University Orthopedic Center at the State University of New York at Buffalo. At the time this article was written, he was a fellow in the Department of Family Medicine at MetroHealth Medical Center.

CATHERINE A. CURLEY, MD, is division director in the Division of Hospital Medicine and an assistant professor of medicine at MetroHealth Medical Center.

Address correspondence to Fassil W. Gemechu, MD, MetroHealth Medical Center, 4229 Pearl Rd., Cleveland, OH 44109 (e-mail: ). Reprints are not available from the authors .

Author disclosure: No relevant financial affiliations.

1. Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care . 1999;22(1):157–162. ...

2. Lipsky BA, Berendt AR, Cornia PB, et al.; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. . 2012;54(12):e132–e173.

3. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. . 2005;366(9498):1719–1724.

4. Vardakas KZ, Horianopoulou M, Falagas ME. Factors associated with treatment failure in patients with diabetic foot infections: an analysis of data from randomized controlled trials. . 2008;80(3):344–351.

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7. Lipsky BA, Peters EJ, Senneville E, et al. Expert opinion on the management of infections in the diabetic foot. . 2012;28(suppl 1):163–178.

8. Mutluoglu M, Uzun G, Turhan V, Gorenek L, Ay H, Lipsky BA. How reliable are cultures of specimens from superficial swabs compared with those of deep tissue in patients with diabetic foot ulcers? . 2012;26(3):225–229.

9. Berendt AR, Peters EJ, Bakker K, et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. . 2008;24(suppl 1):S145–S161.

10. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. . 2008;47(4):519–527.

11. Kapoor A, Page S, Lavalley M, Gale DR, Felson DT. Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis. . 2007;167(2):125–132.

12. Liu C, Bayer A, Cosgrove SE, et al.; Infectious Diseases Society of America. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children [published correction appears in Clin Infect Dis . 2011;53(3):319]. . 2011;52(3):e18–e55.

13. Peters EJ, Lipsky BA, Berendt AR, et al. A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. . 2012;28(suppl 1):142–162.

14. Teh J, Berendt T, Lipsky BA. Rational imaging. Investigating suspected bone infection in the diabetic foot. . 2009;339:b4690.

15. Capriotti G, Chianelli M, Signore A. Nuclear medicine imaging of diabetic foot infection: results of meta-analysis. . 2006;27(10):757–764.

16. Tan T, Shaw EJ, Siddiqui F, Kandaswamy P, Barry PW, Baker M; Guideline Development Group. Inpatient management of diabetic foot problems: summary of NICE guidance. . 2011;342:d1280.

17. Botek G, Anderson MA, Taylor R. Charcot neuroarthropathy: an often overlooked complication of diabetes. . 2010;77(9):593–599.

18. Aragón-Sánchez J, Lipsky BA, Lázaro-Martínez JL. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients? . 2011;28(2):191–194.

19. Lavery LA, Armstrong DG, Peters EJ, Lipsky BA. Probe-to-bone test for diagnosing diabetic foot osteomyelitis: reliable or relic? . 2007;30(2):270–274.

20. Morales Lozano R, González Fernández ML, Martinez Hernández D, Beneit Montesinos JV, Guisado Jiménez S, Gonzalez Jurado MA. Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot. . 2010;33(10):2140–2145.

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34. Prompers L, Schaper N, Apelqvist J, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. . 2008;51(5):747–755.

35. Armstrong DG, Wrobel J, Robbins JM. Guest editorial: are diabetes-related wounds and amputations worse than cancer? . 2007;4(4):286–287.

36. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/ Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. . 2006;113(11):e463–e654.

37. Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. . 2008;31(8):1679–1685.

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