Expert: Alcohol Dependence Is an Epidemic, Yet Treatments Exist

I was beginning to see more and more patients with unhealthy drinking patterns in my primary care office, but I honestly had no idea how to help them. It’s often said that the door a patient knocks on determines which treatment they will receive. As a doctor, I wanted to make sure that when a patient knocks on my door, I’m in a position to help them, which means being as educated as possible about screening for problematic drinking and all available treatment options, including counseling, peer support, and prescription medications. Since I didn’t learn much in medical school about many of these issues, I decided to go back to school to specialize in addiction medicine.

Even before the pandemic, more than 28 million Americans were living with alcohol use disorder, yet less than 8% received any treatment, and only 1% received medication as part of their care.¹ We wouldn’t accept a similar treatment gap for other treatable conditions like cancer or cardiovascular disease, and we shouldn’t accept it with unhealthy drinking either, especially when we have safe and effective treatments at our disposal.

Perhaps it is just that not enough of us know how to help. Maybe we feel that alcohol use is just an accepted part of our culture. Either way, we’ve created a situation in which too few patients in need are being appropriately screened, diagnosed, and then made aware of the treatment options available to them.

But bridging that gap starts with us—health care professionals. We don’t have to be an addiction specialist to make an impact. All of us can and should play a pivotal role in addressing excessive alcohol consumption, the third-leading lifestyle-related cause of death among Americans.³

Unhealthy drinking can be associated with a range of serious consequences in relationships at home, at work, or even with the law. Fortunately, treatment options are available, including behavioral therapy, psychosocial interventions, support groups, and medication assisted treatment (MAT).²

There are several approved MATs for alcohol dependence, including naltrexone. Naltrexone is available as naltrexone hydrochloride (ReVia; Duramed Pharmaceuticals) in a daily oral medication form or as a long-acting once-monthly injection (Vivitrol; Alkermes).

The injection form of naltrexone is approved for the treatment of alcohol dependence. In my experience, patients who receive this injection report they no longer feel a “buzz” from drinking, which frees up space to focus on other aspects of their recovery journey. Getting the monthly injection is an accountability marker for some of my patients and their loved ones; it’s one more positive step they can take as they look to rebuild trust and reexamine the role of alcohol in their lives.

Pharmacists play an important role in the recovery journey for patients who decide MAT is right for them. When it comes to the once-monthly injections of naltrexone, I order the drug and administer it on the same day, but in other cases, a specialty pharmacy ships it to the doctor after the prescription is written, or the patient picks it up at a retail pharmacy to bring back to their doctor. Pharmacies, both specialty and retail, act as a vital link in continuity of care when patients are at their most vulnerable. There are even some pharmacies who administer naltrexoneinjections in-house. This makes the process one step shorter because the patient doesn’t have to go back to the doctor a second time.

In addition to being aware of treatment options, there are several ways we can look to improve the way we address alcohol dependence, such as:

• Increasing education upstream. More information on alcohol dependence can be woven into general curricula for physicians, nurses, and pharmacists, given the rising prevalence in our patient population.
• Strengthening screening. We should consider more screening across health care settings and rethink the assessments we use. Assessments that focus on the consequences of drinking, such as screening tools collated by the National Institutes of Health, may be effective in identifying a person who may need help with alcohol use.
• Being empowered to ask and act more. Whether it’s asking a patient how they’re doing if they seem out of sorts, sharing information on an alcohol contraindication for a medicine being prescribed or asking without judgment about drinking patterns, health care providers across the spectrum can speak up and act more when it comes to patient care.
• Locking arms in partnership. By virtue of their white coats and well-earned community experiences, pharmacists often have longstanding relationships with patients and sometimes may know more about their habits than even their primary doctor. Pharmacists can be integral partners in observing how a patient is doing and sharing insights with the care team, and in assessing or addressing issues where a patient may discontinue medication because of cost or access.

Alcohol dependence is a serious, yet treatable disease, and health care providers can help by increasing awareness and closing the treatment gap between patients who need help and those who receive medical support. No matter whose door a patient knocks on, better education among health care providers can help patients on the right path to recovery.

Author Bio

Abdulhassan Saad, MD, FACP, is a dual board-certified doctor specializing in addiction medicine and internal medicine and has a passion for making health care accessible to communities. Along with providing primary care services at his full-service practice, Dr. Saad also specializes in addiction treatment and management. Saad earned his MD from Toledo School of Medicine and completed his residency from William Beaumont Hospital, Michigan, Abdulhassan Saad has over 10 years of experience in hospital and research settings.

References

1. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the Unites States: Results from the 2020 National Survey on Drug Use and Health.Accessed September 27, 2022. https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf.

2. National Institute on Alcohol Abuse and Alcoholism: Treatment for Alcohol Problems: Finding and Getting Help. Accessed September 27, 2022. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help.

3. National Center for Chronic Disease Prevention and Health Promotion. The Power of Prevention Chronic disease . . . the public health challenge of the 21st century. Accessed September 27, 2022. https://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf.