Support and Treatment for People With Alcohol Use Disorder
Information provided by Alkermes, Inc.
By Abdulhassan Saad, MD, FACP
As a family physician, one condition I see in my practice is alcohol use disorder (AUD), a chronic disease in which a person craves drinks that contain alcohol and is unable to control their drinking.1,2 Someone with this disease also needs to drink greater amounts to get the same effect and has withdrawal symptoms after stopping alcohol use.2 Alcohol use disorder affects physical and mental health and can cause problems with family, friends, and work.2 In 2021, it was estimated that more than 28 million Americans aged 18 years and older, or about one out of every 10 adults, had AUD.3 In fact, one of the reasons I chose to specialize in addiction medicine was the large number of alcohol use disorder cases I was seeing while in family practice.
However, despite the prevalence and impact of alcohol use disorder and our desire to help, as family and primary care physicians, we are often underprepared to support our patients in navigating this challenging disease. In my experience, family physicians commonly receive minimal training on substance use disorders in medical school. And studies show that some family physicians may not be screening patients according to National Institute on Alcohol Abuse and Alcoholism guidelines.4
Screening and Treatment Discussions
The first step in providing clinical support for people living with alcohol use disorder is to make sure we’re screening for it. Commonly accepted screening methods include the CAGE Substance Abuse Screening Tool, the Alcohol Use Disorders Identification Test (AUDIT), and the DSM-5 diagnostic criteria.5,6,7 Alcohol use disorder screening is recommended for all adults, yet only one in six adults report having discussed their drinking with a healthcare professional.8
To begin conversations about alcohol use, it may help to ask patients in plain language about their drinking habits and any consequences they may have experienced as a result of their drinking behaviors.8 We can also remind them that long-term unhealthy drinking behaviors can contribute to heart disease and breast cancer, as well as relationship and legal challenges.8
Additionally, it's important to talk to patients about the variety of evidence-based and effective treatment options for AUD, including behavioral therapy, psychosocial treatments, support groups, and medication-assisted treatment (MAT), which must be prescribed by a healthcare professional and combined with psychosocial support.9 When it comes to MAT, we know that medications approved to treat AUD are underused; in 2022, for example, only about 6.7% of adults diagnosed with AUD were taking medication for it.10
As physicians, we should make it a priority to know about and understand all treatment options so we can provide our clinical expertise in helping our patients evaluate the benefits and risks of each and select the option that best aligns with their individual needs and goals. In my experience, what’s right for one patient at one moment in their treatment journey may not be right for another patient at a different moment, so maintaining open dialogue with patients and their families throughout the treatment and recovery journey is important.
I also encourage clinicians to share their experiences and strategies for treating patients with their colleagues. I have seen firsthand how open dialogue among peers can help reduce stigma, expand understanding, and eliminate barriers that may prevent patients from seeking help.
I believe that with awareness, education, and collaboration, family physicians have a very real opportunity—and really, a responsibility—to help patients living with alcohol use disorder find a treatment approach that may work for them and begin a recovery journey.
Dr. Saad is a paid consultant of Alkermes, Inc. This is Dr. Saad’s perspective and does not represent the perspectives of all healthcare professionals. The information included is not a substitute for professional medical advice. Intended for US healthcare providers only.
Dr. Saad Bio
Abdulhassan Saad, MD, FACP, is a dual board-certified doctor specializing in addiction medicine and internal medicine and has a passion for making healthcare accessible to communities. Saad earned his MD from Toledo School of Medicine and completed his residency at William Beaumont Hospital, Michigan. He has over 10 years of experience in outpatient and research settings.
References
1. National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm. Accessed April 1, 2024.
2. National Cancer Institute. Definition of alcohol dependence. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/alcohol-dependence. Accessed April 1, 2024.
3. National Institute on Alcohol Abuse and Alcoholism. Understanding Alcohol Use Disorder. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder. Accessed April 1, 2024.
4. Spandorfer JM, Israel Y, Turner BJ. Primary care physicians' views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract. 1999;48(11):899-902.
5. Johns Hopkins Medicine. CAGE Substance Abuse Screening Tool. hopkinsmedicine.org. https://www.hopkinsmedicine.org/-/media/johns-hopkins-health-plans/documents/all_plans/cage-substance-screening-tool.pdf. Accessed April 1, 2024.
6. HHS Substance Abuse and Mental Health Services Administration. Alcohol Use Disorders Identification Test (AUDIT). https://www.samhsa.gov/resource/dbhis/alcohol-use-disorders-identification-test-audit. Accessed April 1, 2024.
7. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
8. Centers for Disease Control and Prevention. Vital Signs. Alcohol Screening and Counseling: An effective but underused health service. cdc.gov. https://www.cdc.gov/vitalsigns/alcohol-screening-counseling/index.html. Accessed April 1, 2024.
9. National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help. niaaa.nih.gov. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help#pub-toc1. Accessed April 1, 2024.
10. Hu H, Mitra R, Han Y. Prevalence and treatment for alcohol use disorders based on Kentucky Medicaid 2012–2019 datasets. J Alcohol Drug Depend. 2022;10(5):1000366.
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