Alcohol abuse is on the rise. Here’s why doctors don’t treat it.

Like many people who struggle to control their drinking, Andy Mathisen has tried many ways to reduce his consumption.

He attended Alcoholics Anonymous meetings, went to a drug rehab center, and tried to use his willpower to keep himself from drinking excessively. But nothing seemed to work. Last year, with the stress of the pandemic hanging over him, he found himself craving beer every morning, drinking in his car and polishing two liters of scotch a week.

Frustrated and feeling that his health and future were on a downward spiral, Mr. Mathisen took to the internet and discovered Ria Health, a telehealth program that uses online coaching and medication to help people get on top of their health. alcohol consumption without necessarily giving up alcohol altogether.

After signing up for the service in March, he received coaching and a prescription for naltrexone, a drug that decreases cravings and dulls the alcohol buzz. The program accepts some insurance and charges $ 350 per month for a one-year commitment for people who pay out of pocket. Since starting to use it, Mr. Mathisen has significantly reduced his alcohol consumption, limiting himself to one or two drinks a few days a week.

“My alcohol consumption has decreased significantly,” said Mr. Mathisen, 70, a retired telecommunications manager who lives in central New Jersey. “It no longer controls my life. “

Mr. Mathisen is one of the about 17 million Americans who are struggling with alcoholism, the colloquial term for alcohol use disorders, a problem that was exacerbated last year as the pandemic drove many anxious and isolated people to drink alcohol. excess. the National Institutes of Health define disorder as “a medical condition characterized by a reduced ability to stop or control alcohol consumption despite adverse social, occupational or health consequences”. Yet despite its prevalence, most people with the disease do not receive treatment, even when they disclose their drinking problem to their primary care doctor or other health care professional.

Last month, a national study by researchers at the Washington University School of Medicine in St. Louis found that about 80 percent of people who met criteria for alcohol use disorder had visited a doctor, hospital, or medical clinic for various reasons during the previous year. About 70 percent of these people were asked about their alcohol consumption. Yet only one in ten has been encouraged to cut down on alcohol by a health professional, and only 6 percent have received some form of treatment.

Alcohol abuse can be motivated by a complex array of factors, including stress, depression, and anxiety, as well as a person’s genetics, family history, and socioeconomic circumstances. Many people get rid of their heavy drinking on their own or through self-help programs like Alcoholics Anonymous or SMART recovery. But relapse rates are noticeably high. Research suggests that of all people with alcohol use disorders who try to quit drinking each year, only 25% are successful in reducing their alcohol consumption in the long term.

While there is no quick fix for alcohol use disorder, several drugs have been approved to treat it, including pills like acamprosate and disulfiram, as well as oral and injectable forms of naltrexone. These drugs can dull cravings and reduce cravings to drink, which makes it easier for people to stop or cut back when combined with behavioral interventions like therapy.

Yet despite their effectiveness, doctors rarely prescribe the drugs, even to those most likely to benefit from them, in part because many doctors are not trained to treat addiction or informed of the drugs approved to treat it. In a study published last month, NIH scientists found that only 1.6 percent of the millions of Americans with alcohol use disorders were prescribed a drug to help them control their drinking. “These are potentially life-saving drugs, and what we found is that even among people with diagnosed alcohol use disorder, the rate of use is extremely low,” said Dr. Wilson. Compton, study author and deputy director of the National Institute on Drug Abuse.

The implications of this are substantial. Alcohol is one of the most common forms of drug addiction and a leading cause of preventable death and disease, killing people nearly 100,000 Americans every year and contributing to millions of cancers, car accidents, heart attacks and other illnesses. It is also a major cause of occupational accidents and loss of productivity at work, as well as a frayed family driver and personal relationships. Yet, for a variety of reasons, people who need treatment rarely get it from their doctor.

Some physicians adhere to the stereotype that people struggling with alcohol are difficult patients with an intractable disease. Many patients who sign up for services like Ria Health do so after being turned away by doctors, said Dr. John Mendelson, professor of clinical medicine at the University of California at San Francisco and chief medical officer at Ria Health. . “We have patients who come to see us because they have been fired by their doctors,” he added.

In other cases, physicians with no experience with substance abuse may worry that they do not have the expertise to treat alcoholism. Or they may feel uncomfortable prescribing drugs for it, even if it doesn’t require special training, said Dr. Carrie Mintz, assistant professor of psychiatry at the University of Washington and co-author of the ‘study last month that looked at treatment rates nationwide. .

The result is that many patients end up being referred to mental health experts or referred to rehabilitation centers and 12-step programs like AA.

“There is a stigma associated with substance use disorders, and treatment for them has always been outside the health care system,” said Dr. Mintz. “We think these extra steps of referring people to treatment are a barrier. We argue that treatment should take place there, at the point of care, when people are in the hospital or clinic. “

But another reason for low treatment rates is that problem drinkers are often in denial, said Dr Compton of the National Institute on Drug Abuse. Studies show that most people who meet the criteria for an alcohol use disorder do not feel they need treatment for it, even when they admit they all have the characteristics of the state, such as trying to cut down on alcohol in vain, having strong cravings, and continuing to drink despite health and relationship problems.

“People are perfectly willing to talk to you about their symptoms and the challenges they are facing,” said Dr Compton. “But then if you say, ‘Do you think you need treatment?’ they will say no. There is a blind spot when it comes to putting these pieces together.

Studies suggest that a major barrier to people seeking treatment is that they believe abstinence is their only option. This perception is driven by the pervasiveness and long history of 12-step programs like AA that preach abstinence as the only solution to alcoholism. For some people with severe drinking problems, this may be necessary. But studies show that people with milder forms of alcohol use disorder may improve their mental health and quality of life, as well as their blood pressure, liver health and other aspects of their physical health, reducing their alcohol consumption without completely stopping alcohol. Yet the idea that the only option is to quit cold turkey may prevent people from seeking treatment.

“People think abstinence is the only way – and in fact it’s not the only way,” said Katie Witkiewitz, director of the Addictive Behaviors and Quantity Research Lab at the University of New Mexico. and past president of the Society of Addiction Psychology. . “We’re seeing solid improvements in health and functioning when people cut back on alcohol, even if they don’t cut back on abstinence. “

For people who are worried about their alcohol consumption, Dr. Witkiewitz recommends tracking exactly how much you drink and then setting goals based on how much you want to reduce your intake. If you typically consume 21 drinks a week, for example, removing just five to 10 drinks – alone or with the help of a therapist or medication – can make a big difference, Dr Witkiewitz said. “Even this level of reduction will be associated with improvements in cardiovascular function, blood pressure, liver function, quality of sleep and overall mental health,” she added.

Here are some tools that can help you.

  • Health Ria is a telehealth program that provides treatment for people with alcohol use disorders. It offers medical consultations, online coaching, medication and other tools to help people reduce their alcohol consumption or abstain if they wish. It costs $ 350 per month for the annual program, cheaper than most rehab programs, and accepts some forms of health insurance.

  • The National Institute on Alcohol Abuse and Alcoholism has a free website called Rethinking Alcohol Consumption who can help you find doctors, therapists, support groups, and other ways to get treatment for a drinking problem.

  • Reduction coach is a popular app that helps people track their alcohol consumption and set goals and reminders so they can develop healthier drinking habits. The service allows people to track their progress and sends out daily reminders to motivate themselves. The cost is $ 79 if you pay annually, $ 23 per quarter or $ 9 per month.

  • Moderation management is an online forum for people who want to reduce their alcohol consumption but not necessarily abstain. The group offers meetings, online and in person, where members can share stories, tips and coping strategies. He also maintains an international directory of “friend of moderation” therapists.

  • Assessment and choice is a web-based program that tracks alcohol use disorders. It provides information on your consumption habits and reduction options. The service costs $ 79 for three months or $ 149 per year.

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