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 One in four American adults binges on alcohol at least once a month,
and one in 15 binges five or more times a month, researchers report
in JAMA. For males, binging means consuming at least five standard
drinks on a single occasion; for females; it means consuming four
standard drinks on one occasion.
Even though there are three medications approved to treat alcohol
use disorders in the U.S., most people only get treated with
counseling.
Because alcohol use disorder is stigmatized, people generally don't
tell doctors that they drink heavily, and physicians tend not to
ask, said study co-author Dr. Henry Kranzler, director of the Center
for Studies of Addiction at the University of Pennsylvania Perelman
School of Medicine in Philadelphia.
Even when patients do get diagnosed with a drinking problem,
treatment is often fragmented and inaccessible, Kranzler said by
email.
Only about 8 percent of people with serious drinking problems get
care in an alcohol treatment facility. And less than 9 percent
receive prescriptions for drugs that might help them cut back or
stop drinking.
Available medications for alcohol use disorder work in different
ways.
The oldest, disulfiram, stops an enzyme from breaking down a toxic
byproduct of alcohol. As a result, people who drink experience
symptoms like nausea, headaches and weakness - which may discourage
some people from drinking.
Naltrexone, which blocks some of the naturally occurring opioids in
the brain's pleasure center, is available as a short-acting pill or
a long-acting injection. By dulling the pleasure of drinking, this
drug may help some people avoid binges.
A third drug, acamprosate, appears to help abstinent patients
maintain their avoidance of alcohol by attacking pathways in the
brain that may make people more prone to alcoholism.
To get prescriptions to more patients who might benefit from these
drugs, primary care providers will need to make a concerted effort
to screen patients, researchers note.
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Screening is relatively simple and can be done with a few questions.
Then patients with a diagnosis of alcohol use disorder can be given
counseling and prescribed medications.
Failing to do this takes a heavy toll: alcohol is associated with
88,000 deaths in the U.S. every year, researchers note.
But while routine screening for heavy alcohol use has been
recommended, only one in six U.S. adults reports ever having been
asked by a health professional about their drinking behavior, the
study authors point out.
"It is clear that there are medicines doctors can prescribe and
health professionals . . . like psychologists and social workers who
can counsel patients with evidence-based therapies," said Dr.
Richard Saitz, an associate editor for JAMA and a professor at the
Boston University School of Public Health.
"But these treatments are not widely available in general health
settings," Saitz, author of an accompanying editorial, said by
email. "So, doctors may not diagnose because treatments are not
easily available to them to implement."
Once doctors diagnose a problem and recognize the treatment options,
they still need patients to accept they need help, Saitz added.
"Patients may not seek help because heavy drinking affects their
motivation and recognition that they have a condition that needs
attention," Saitz said.
SOURCE: http://bit.ly/2Pg2qbW JAMA, online August 28, 2018.
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