Alcohol Use Disorders in Primary Care

Date: 

04/30/2014

Issues related to alcohol “are among the most significant public health issues in the United States and internationally.” The 2010 National Survey on Drug Use and Health reported that in the preceding year, 70% of Americans 18 years older (161 million adults) had used alcohol and that 9% of adults (20 million) had qualified for an alcohol or drug use disorder. Currently, about 18 million Americans have an Alcohol Use Disorder (AUD). AUDs “are associated with detrimental physical, social, and psychological consequences.” In 2006, alcohol problems cost the United States $224 billion due to mostly lost productivity. Health care and property damage expenses also accounted for the cost. Additionally, AUDs often co-occur with mental health disorders and/or abuse of other drugs.

Americans with alcohol or drug use disorders are “overrepresented” in primary care where AUDs often cause or undermine treatment for health problems or mental health disorders. Yet, adults are not commonly asked about their alcohol use when they visit a general practitioner. In a survey of 7371 adults that visited a medical practitioner, only a little over a third aged 18-49 “were asked about alcohol and drug use” and those over 49 years of age “were asked less often.” Furthermore, only a small number of people were ever treated for AUDs in primary care settings.

Resources such as the U.S. Preventative Services Task Force (USPSTF) recommendations and Treatment Improvement Protocol (TIP) 49 assert that treatment of AUDs by health care practitioners in primary care “is both possible and practical”. Moreover, the Affordable Care Act (ACA) of 2010 calls for “the integration of substance abuse interventions and treatments into the mainstream health care system.” Specifically, the USPSTF offers “recommendations for screening and behavioral counseling” for alcohol-related problems in primary care settings. Screening can identify those at risk for adverse health outcomes due to alcohol misuse and counseling can reduce alcohol consumption. TIP 49, developed by the Substance Abuse and Mental Health Services Administration, provides evidence-based tools, guidelines, and resources— including information on treatment medications—to help general practitioners treat people with AUDs.

Barriers to addressing AUDs in primary care include limited financial resources and provider time. Fortunately, the ACA is expected to relieve these issues particularly with regard to funding. On the other hand, treatment for alcohol-related disorders is expected to offer many advantages to patients. These include integrated screening, diagnosis and treatment, integration of AUD treatment with that of comorbid medical conditions, familiarity with the primary care setting, reduced stigma, and ongoing rapport with the general practitioner that could make patients more comfortable with referral to substance abuse specialty care. With an integrated approach to alcohol-problems in primary care, professional help and evidence-based treatment can establish healthier drinking habits, prevent relapse, and provide holistic care for patients with AUDs.

Read about the USPSTF: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339489/pdf/sar-3-025.pdf

Read about TIP 49: http://www.ncbi.nlm.nih.gov/books/NBK64041/pdf/TOC.pdf