In the shadow of the opioid crisis, we often forget how pervasive and damaging alcohol misuse is until we get reminders like the story of three Indiana Supreme Court judges who got into a drunken fight outside a White Castle restaurant last week, leading to their suspension.
We know alcohol kills — 88,000 Americans die from alcohol-related causes each year. But we need to face the fact that it destroys lives and careers, too. None of this has to happen if we embrace the right treatment options.
Alcohol disorders have increased dramatically across most U.S. socio-demographic subgroups ( women, older adults, racial/ethnic minorities, and the socio-economically disadvantaged). One in five who die from opioid overdoses have alcohol in their system at the time of their death.
Complicating the picture, there is a lack of information amongst providers and patients alike; not all providers are aware of the potential consequences when medical treatment is withheld from those in need; patients may not have all the information about their risks or available treatment options.
Colleges are under increased scrutiny as more stories of alcohol related injuries and deaths mount. Recent deaths attributed to alcohol include Cranberries singer Dolores-O’Riordan, rapper Mac Miller, singer and songwriter Amy Winehouse, and adult film actress Jessica Jaymes, to name just a few.
Alcohol is the most common problem encountered by primary care providers, yet the one they are least able to manage. Often missing from treatment is discussion of medication as an option. It is still rare for a person struggling with alcohol to hear that medication therapy exists.
Only 20 percent of people with drinking problems receive any form of treatment, ranging from seeing a clinician to entering a treatment program. Many are forced to do so by a court, a family member, or an employer after they land in hot water like those three judges.
People in alcohol treatment, then, often have the most serious problems. Yet less than 10 percent of them are prescribed medications, which are very effective.
Mutual help groups like twelve step programs remain the most commonly sought source of help for alcohol use disorders in the United States. Many believe the only other alternative is abstinence-based rehab but those programs have their limitations too; drinkers are detoxed, lose their tolerance, keep the cravings, and may drink more after discharge.
Naltrexone and acamprosate are the two drugs on the market for patients with alcohol cravings and they’re effective. Both are easily tolerated and produce few side effects. There’s ample evidence they work.
Only about 15 percent of those with alcohol use disorder are at the severe end of the spectrum, which means that 85 percent of them have some hope of staying away from that extreme. Medical treatment can really help them.
A lack of training among medical professionals contributes to the underuse of medications. In a recent national study, 67 percent of psychiatrists and 88 percent of family physicians said they would be more likely to prescribe medications for alcohol use disorder if they received the education needed.
Things may be changing, though. Some medical institutions have begun ramping up outreach about medications and behavioral therapies to both patients and providers. A movement to start training in medical school and continue throughout one’s medical career is taking hold, often demanded by early learners.
Medications are important because there are a range of alcohol problems. Most drinkers fall somewhere in the mild-to-moderate range, or may not qualify for a disorder but may be “at-risk drinkers” according to daily acceptable standards. Both groups, the hard-core user and the more moderate over-drinkers, can benefit from FDA approved medications and proven behavioral therapy.
There’s another barrier to using medications to treat alcohol use disorder, an attitudinal one. The “general hopelessness of the alcoholic’s plight” is accepted by patient and clinician as fact. Because of our dedication to this hopeless narrative, there has long been resistance to the idea that alcohol disorders can be medically treated. This view of people with alcohol-related is part of Americans’ addiction to stigmatizing substance use problems even though they’re a medical affliction.
Contrary to popular opinion, denial is not a primary reason people do not seek treatment. The United States’ inability to embrace the public health and medical aspects of excessive alcohol has caused shame amongst patients and confusion amongst practitioners. A typical response to problem drinking is to worry about it until calamity causes someone or some agency to intervene.
While it’s true that some individuals with alcohol problems manage to recover on their own without formal treatment, there are also some who achieve partial remission, and others who cycle in and out of alcohol problems throughout their lives.
To suggest that we shouldn’t use all treatment options — which would include medications — to help all people struggling with alcohol when the stakes are so high is irresponsible.