Jürgen Rehm1, Peter Anderson2, Jakob Manthey3, Kevin D Shield4, Pierluigi Struzzo5, Marcin Wojnar6, Antoni Gual7. 1. Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8, Canada Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada jtrehm@gmail.com. 2. Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, 6221 HA Maastricht, Netherlands. 3. Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany. 4. Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada. 5. Department of Life Sciences, University of Trieste, Via Weiss 2 - Pal. Q - 34128 Trieste, Italy Center for Study and Research in General Practice (Ceformed), Via Galvani 1, 34074 Monfalcone, GO, Italy. 6. Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland Department of Psychiatry and Addiction Research Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA. 7. Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036 Barcelona, Spain (Catalonia) Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036 Barcelona, Spain (Catalonia) Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Calle Sinesio Delgado, 4, 28029 Madrid, Spain.
Abstract
AIMS: To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care. METHODS: Analyses of guidelines and recommendations, reviews and meta-analyses. RESULTS: Many recommendations or guidelines for interventions for people with alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: screening for alcohol use and alcohol-related problems, brief interventions for hazardous and in some cases harmful drinking, referral to specialized treatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders). CONCLUSIONS: A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.
AIMS: To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care. METHODS: Analyses of guidelines and recommendations, reviews and meta-analyses. RESULTS: Many recommendations or guidelines for interventions for people with alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: screening for alcohol use and alcohol-related problems, brief interventions for hazardous and in some cases harmful drinking, referral to specialized treatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders). CONCLUSIONS: A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.
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