Canadian clinicians and researchers have created a new guideline to help health professionals broach the topic of risky drinking with patients and connect them to effective treatment.
The guideline, published Monday in the Canadian Medical Association Journal, is the first of its kind in the country, at a time when high-risk drinking is relatively common while medical intervention is rare.
“The whole system of care needs to be established, and really, we’re at the ground floor,” said Evan Wood, co-chair of the guideline committee and an addiction medicine specialist based at the University of British Columbia.
According to the guideline, nearly one in five people 15 and older will meet clinical criteria for an alcohol-use disorder in their lifetime, while nearly 60 per cent drink more than advised under Canada’s national alcohol consumption recommendations, which were published earlier this year. The recommendations note that health risks start to escalate when a person consumes three to six alcoholic drinks a week, and that seven or more drinks is linked to worse outcomes.
Alcohol-use disorder is defined as a pattern of heavy drinking and loss of control over intake despite negative consequences. While high-risk drinking is common, very few individuals ever get treatment, according to clinicians who helped create the new guideline.
“We have a disease condition which is fairly widespread,” said Jürgen Rehm, co-chair of the guideline committee and senior scientist in the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health. “Only a small minority get treatment, and that treatment is often false.”
Dr. Rehm said that people when people with alcohol-use disorder to get help, they are often prescribed anti-depressant medications known as selective serotonin reuptake inhibitors, or some anti-psychotic drugs to alleviate symptoms. But mounting evidence shows those drugs don’t actually help and, in the case of SSRIs, can actually lead to worsening cravings.
The new guideline contains a list of recommendations to help diagnose individuals and lead them to treatments that can help manage symptoms and reduce short-term and long-term health risks. One recommendation suggests health professionals screen patients for alcohol-use disorder about once a year.
If patients meet the criteria for a disorder, the recommendations walk health professionals through possible next steps, including medication or other interventions to help individuals manage any mild or severe withdrawal symptoms. The guideline also advises professionals and how to connect patients to therapy and medication to help them over the long term.
The recommendations advises against the use of SSRIs or anti-psychotic drugs to treat alcohol-related conditions.
Dr. Rehm said he hopes the guideline can help reduce some of the stigma around alcohol use, which can prevent patients and care providers from speaking about it: “It is often not seen as a disease. It’s basically seen as people who don’t have a strong will who are weak and it’s their fault.”
This stigma is often more prevalent for women, Dr. Rehm said, as it’s considered less socially acceptable for them to drink to excess – thus making them more prone to hiding problematic alcohol consumption patterns.
In addition, he said, some health professionals may avoid the topic because they’re unsure how to help patients or what the best treatments are, which is where the new guideline can help.