Guidelines for treatment of alcohol problems notes risks, stigma

Scaling up the treatment of alcohol problems will lead to considerable health benefits across the nation, according to experts who led the development of updated alcohol treatment guidelines on behalf of the federal government recently. 

The key guideline changes and implications were highlighted in a supplement, editorial and podcast published yesterday by the Medical Journal of Australia (MJA).

Professor Paul Haber, Clinical Director of Drug Health Services, Sydney Local Health District, and professor of Addiction Medicine at the University of Sydney’s Central Clinical School, and colleagues, wrote that each year in Australia alcohol use was linked to about 150,000 hospital admissions and 6000 deaths.

“[Alcohol] remains the most common substance-use problem seen in specialist treatment services,” the authors wrote.

Professor Haber, from the University of Sydney’s Faculty of Medicine and Health, was responsible for updating the latest version of the Guidelines for the Treatment of Alcohol Problems; the present version of the Guidelines was commissioned by the Commonwealth of Australia to remain current and integrated with the updated National Health and Medical Research Council's consumption guidelines (2020).

Today’s MJA pieces about the new Guidelines, lead authored by Professor Haber, explains the updates include new sections about at-risk groups that had not been carefully considered in previous versions. The Guidelines note that although a suite of treatment options are widely available, because of stigma and lack of awareness, treatment is seldom discussed.

The median delay between onset of alcohol problems and treatment in Australia is about 18 years; as well, pharmacotherapies are prescribed in fewer than 5 percent of cases.

In the MJA editorial, it is noted that alcohol is Australia’s most widely used drug, with alcohol-use disorder in Australia affecting anywhere from 800,000  to more than a million  and measures of alcohol-related harm such as hospitalisation appearing not to decline, despite alcohol use declining overall.

The MJA Supplement, "New Australian guidelines for the treatment of alcohol problems: an overview of recommendations", notes that alcohol problems are not distributed equally through the population. 

The guidelines note that alcohol problems are more common among those with a family history; in men; among those living outside the metropolitan areas; and among individuals and populations exposed to high levels of trauma and stress, especially adverse childhood experiences.

“Routine clinical assessment typically detects severe cases but misses out on the less severely affected. It is the treatment of less severe cases that has the greatest potential to prevent life‐threatening complications,” warns Professor Haber and colleagues.

“Brief interventions are easily offered in primary care or other healthcare settings and can be effectively delivered online,” the paper reads. “[As well] a number of culturally specific strategies for engagement have evolved to assist members of specific communities with alcohol problems. 

Therefore, the guidelines now include sections on screening, brief interventions, and eight chapters dedicated to the treatment of specific populations.

Key findings and challenges include:

• alcohol problems are not distributed equally through the population;
• alcohol use disorder is associated with many mental, physical and social complications that can make management more challenging; specific chapters focus on polydrug use, mental comorbidities, and physical comorbidities;
• alcohol-use disorder is heavily stigmatised and may explain the reluctance to implement alcohol treatment programs to the populations at risk and in the places where they are needed; the guidelines include a new chapter addressing stigma;
• treatment services are often poorly resourced and increasing awareness of available evidence-based treatment options may have a key impact on treatment seeking. For example, ambulatory withdrawal management is effective for low-risk patients and can be offered by general practitioners as well as specialist services. Treatment should be continued long term.

“Improving the efficacy and implementation of comprehensive and effective treatment is a priority and has the potential to save lives and return value to the community,” Professor Haber and colleagues wrote. 

“This will require expansion of discovery and translational research, clinical training and advocacy. 

“With almost 5 percent of the national burden of disease and injury attributable to alcohol, investing in scaling up treatment of alcohol problems will undoubtedly be associated with considerable health benefit across the nation,” they concluded.

The MJA supplement, which links to the podcast and editorial, as well as an MJA InSight+ report, is available in open access.

Image sourced from Shutterstock

Declaration:

Paul Haber has been funded by the University’s Lambert Initiative for Cannabinoid Therapeutics to undertake clinical trials of cannabinoid treatment for alcohol withdrawal syndrome; has served on industry advisory boards for Indivior, AbbVie and Gilead; and has been an investigator on clinical trials supported by Camurus. He has also served on international and Australian advisory boards for Lundbeck in relation to nalmefene (2013–2015 and 2014, respectively). MJA supplements are peer-reviewed, paid 'stand-alone' style publications subject to a competitive process.