Support Individuals Who Abuse Alcohol

As trusted health care professionals, community pharmacists have a responsibility to support patients who abuse alcohol.

According to the 2019 National Survey on Drug Use and Health, 14.5 million individuals in the United States have alcohol use disorder (AUD) and alcohol-related causes are the third-leading cause of preventable death in the United States behind tobacco use and poor diet and physical inactivity.¹ Pharmacists can screen and educate patients about various conditions, including AUD.

Rationale

Many medications interact with alcohol.² These interactions have broad consequences, such as increased risk of dizziness, drowsiness, and gastrointestinal bleeding. Heavy alcohol consumption worsens many chronic conditions, including cancer, cardiovascular disease, diabetes, digestive disorders, and liver disease. Mental health disorders often co-occur with AUD.^2,3 Pharmacists can explore a patient’s alcohol use during consultation for medication that interacts with alcohol and when dispensing medications for comorbidities or conditions affected by alcohol abuse.⁴

Community pharmacists’ accessibility goes beyond filling patients’ prescriptions. Patients may request advice for managing minor, limiting alcohol-associated symptoms.⁴ These include OTC medications for emergency contraception, hangovers, headaches, indigestion, minor injuries, nausea, and vomiting. These conditions warrant probing about alcohol use.⁴

Pharmacists must use a short, validated tool that is easily implemented when screening for AUD. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a practical screening tool (Table 1).⁵

The pharmacist’s next steps vary. They must have communication and therapeutic skills to navigate AUD conversations.⁴ Pharmacists should refer patients to a physician if they suspect potential AUD. The American Psychiatric Association recommends patient-centered treatment with nonpharmacological and pharmacological components.³

Appropriate Therapy

Evidence-based AUD nonpharmacologic treatment includes motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT). MET is a technique derived from motivational interviewing, in which patient’s beliefs and goals drive change. MET is typically a 90-day, 4-session framework.⁶ CBT integrates behaviors, feelings, and thoughts, helping manage drinking-associated triggers.⁷

Despite high AUD prevalence, less than 4% of individuals are prescribed any of the 4 FDA-approved treatments for moderate-to-severe AUD1: oral acamprosate (Campral), oral disulfiram (Antabuse), intramuscular naltrexone (Vivitrol), and oral naltrexone (Revia). Gabapentin and topiramate are used off label as treatments. Table 2 provides information regarding the FDA-approved medications.^8,9,10,11 When identifying adherence barriers or unsuccessful treatment, pharmacists should refer patients to their physicians for potential therapeutic changes.

Limited literature examines pharmacist screening and brief interventions related to substance use disorder, so more evidence is needed.⁴ Community pharmacists are expanding their role to offer advanced services, including chronic disease screening and management, smoking cessation, and treatment of minor ailments.¹² Eventually, community pharmacies may offer brief screening interventions for AUD. Like for many services, reimbursement and staffing will be a challenge to implementing AUD interventions.

Conclusion

From being the first health care contact to screening patients with potential comorbidities to counseling patients undergoing treatment, pharmacists can support individuals who abuse alcohol. Pharmacists must have the appropriate communication and therapeutic skills to manage this sensitive subject.

Linsday Sawtelle is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.

References

1. Alcohol facts and statistics. National Institute on Alcohol Abuse and Alcoholism. Updated March 2022. Accessed March 1, 2022. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

2. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54.

3. Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry.2018;175(1):86-90. doi:10.1176/appi.ajp.2017.1750101

4. Hattingh HL, Tait RJ. Pharmacy-based alcohol-misuse services: current perspectives. Integr Pharm Res Pract. 2018;7:21-31. doi:10.2147/IPRP.S140431

5. Kriston L, Hölzel L, Weiser AK, Berner MM, Härter M.Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann Intern Med. 2008;149(12):879-888. doi:10.7326/0003-4819-149-12-200812160-00007

6. Lenz AS, Rosenbaum L, Sheperis D. Meta-analysis of randomized controlled trials of motivational enhancement therapy for reducing substance use. J AddictOffender Couns. 2016;37(2):66-86. doi:10.1002/jaoc.12017

7. Epstein EE, McCrady BS. A Cognitive-Behavioral Treatment Program for Overcoming Alcohol Problems: Therapist Guide. Oxford University Press; 2022.

8. Revia. Prescribing information. Duramed Pharmaceuticals Inc; 2013. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/018932s017lbl.pdf

9.Vivitrol. Prescribing information. Alkermes, Inc; 2021. https://www.vivitrol.com/content/pdfs/prescribing-information.pdfComments restricted to single page

10. Campral. Prescribing information. Forest Pharmaceuticals, Inc; 2005. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021431s013lbl.pdf

11. Antabuse. Prescribing information. Duramed Pharmaceuticals Inc; 2010. file:///C:/Users/cmollison/Downloads/20120420_12850de3-c97c-42c1-b8d3-55dc6fd05750.pdf

12. Mossialos E, Courtin E, Naci H,et al. From “retailers”to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015;119(5):628-639. doi:10.1016/j.healthpol.2015.02.007