Alcohol Abuse Is Increasing. Here’s Why Doctors Can’t Treat It.


Like many people who have trouble controlling their drinking, Andy Mathisen has tried many ways to reduce it.

He attended Alcoholics Anonymous meetings, went to a rehab center for alcohol abuse, and tried to use his willpower to stop himself from binge drinking. But nothing seemed to work. Last year, with the stress of the pandemic coming upon him, he found himself craving a beer every morning, drinking in his car, and polishing two liters of whiskey a week.

Frustrated and feeling that his health and future are in a downward spiral, Mr. Mathisen turned to the internet and discovered Ria Health, a telehealth program that uses online coaching and medication to help people rein in their drinking without giving up alcohol completely.

After enrolling in the service in March, she received coaching and was given a prescription for naltrexone, a drug that reduces cravings and blunts the buzz from alcohol. The program accepts some insurance and charges $350 a month for a one-year commitment for out-of-pocket payers. Mr. Mathisen has drastically reduced his drinking since he started using it and has limited himself to just one or two drinks a few days a week.

“My alcohol consumption has dropped tremendously,” said Mr. Mathisen, 70, a retired telecommunications executive living in central New Jersey. “It no longer controls my life.”

Mr. Mathisen, roughly 17 million Americans colloquial term for alcohol use disorder struggling with alcoholism, a problem intensified last year as the pandemic has pushed many anxious and isolated people to binge drinking. The National Institutes of Health defines the disorder It is defined as “a medical condition characterized by impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences”. Yet, despite how common it is, most people with the disorder do not seek treatment for it, even if they explain their alcohol problem to their primary care doctor or other healthcare professional.

Last month, a nationwide study Researchers at Washington University School of Medicine in St. Louis found that nearly 80 percent of people who met the criteria for alcohol use disorder had gone to a doctor, hospital, or medical clinic in the previous year for a variety of reasons. About 70 percent of these people were asked about their alcohol intake. Yet only one in 10 was encouraged by a healthcare professional to reduce their drinking, and only 6 percent received any treatment.

Alcohol abuse can be driven by a complex set of factors, including a person’s genetics, family history, and socioeconomic conditions, as well as stress, depression, and anxiety. Many people break the habit of heavy drinking on their own or through self-help programs such as: Alcoholics Anonymous or SMART Recovery. However, recurrence rates are high as everyone knows. Research shows that Among all people with alcohol use disorder who try to stop drinking each year, only 25 percent are able to successfully reduce their alcohol intake over the long term.

While silver lead is not available for alcohol use disorder, several medications are approved to treat it, including pills such as acamprosate and disulfiram, as well as oral and injectable forms of naltrexone. These drugs reducing blunt cravings and urges When combined with behavioral interventions such as therapy, it makes it easier for people to quit or reduce smoking.

Yet despite their effects, doctors rarely prescribe drugs, even for those most likely to benefit from them, partly because most doctors are not trained to deal with addiction or are trained in approved drugs to treat it. In a study published last monthScientists at the NIH found that only 1.6 percent of the millions of Americans with alcohol use disorder are prescribed a medication to help them control their drinking. The author and deputy director of the study, Dr. “These are potentially life-saving drugs, and we found that use rates are extremely low, even in people with diagnosable alcohol use disorders,” said Wilson Compton. National Institute on Drug Abuse.

The implications of this are significant. Alcohol is one of the most common forms of substance abuse and the leading cause of preventable death and illness. almost 100,000 Americans It contributes to millions of cancers, car accidents, heart attacks and other ailments each year. Same time major cause of work accidents and loss of work efficiency as well as driver of a worn-out family and personal relationships. Yet people who need treatment for a variety of reasons rarely get it from their doctor.

Some doctors hold the stereotype that people who struggle with alcohol are difficult patients with a stubborn condition. Many patients who sign up for services like Ria Health do so after being turned down by doctors, says Dr. John Mendelson. “We have patients who come to us because they were fired by their doctors,” he added.

In other cases, doctors without a history of addiction may be concerned that they do not have the expertise to treat alcoholism. D., an assistant professor of psychiatry at the University of Washington and co-author of the study last month that looked at cure rates nationwide. Carrie Mintz said that although it does not require special training, they may feel uncomfortable prescribing medication for it. .

As a result, many patients are referred to mental health professionals or sent to rehabilitation centers and 12-step programs such as AA.

Dr. “There is a stigma associated with substance use disorders, and their treatment has historically been outside the healthcare system,” Mintz said. “We think these extra steps of having to refer people for treatment are a hindrance. We advocate that when people are in the hospital or clinic, treatment should be done right there at the point of care.”

But another reason for low cure rates is that problem drinkers are often in denial, says Dr. Compton. Studies show Most people who meet the criteria for alcohol use disorder do not need treatment, even if they admit they have an alcohol use disorder. distinguishing features of the situationsuch as trying to quit alcohol in vain, experiencing cravings, and continuing to drink despite causing health and relationship problems.

Dr. “People are extremely willing to tell you about their symptoms and difficulties they are facing,” Compton said. “But then ‘Do you think you need treatment?’ if you say. They will say they didn’t. There is a blind spot when it comes to putting these pieces together.”

Research shows that the biggest barrier to people seeking treatment is that they believe their only option is abstinence. This perception is driven by the prevalence and long history of 12-step programs like the AA that preach abstinence as the only solution to alcoholism. This may be necessary for some people with severe drinking problems. However, research has shown that people with milder forms of alcohol use disorder improve their mental health and quality of life, blood pressure, liver health and other aspects of their physical health, by reducing their alcohol intake without giving up alcohol completely. Still, the idea that the only option is to quit cold turkey may deter people from seeking treatment.

“People believe abstinence is the only way—and it’s actually not the only way,” said Katie Witkiewitz, director of the Addictive Behaviors and Quantitative Research Laboratory at the University of New Mexico and former president of the Association for Addiction Psychology. . “We find strong improvements in health and functioning when people reduce their drinking, even if they don’t fall into abstinence.”

For people concerned about their alcohol intake, Dr. Witkiewitz recommends keeping track of exactly how much you drink and then setting goals based on how much you want to reduce your intake. Dr. If you’re consuming 21 drinks a week, for example, cutting out just five to 10 drinks on your own or with the help of a therapist or medication can make a big difference, Witkiewitz said. “Even this level of reduction will be associated with improvements in cardiovascular function, blood pressure, liver function, sleep quality, and mental health in general,” he added.

Here are some tools that can help.

  • Ria Health is a telehealth program that offers treatment to people with alcohol use disorders. It provides medical consultations, online coaching, medications and other tools to help people reduce their alcohol intake or stay away from alcohol if they prefer. It costs $350 a month for the annual program, is cheaper than most rehabilitation programs, and accepts some types of health insurance.

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

  • Downtime Coach is a popular app that helps people track their alcohol intake and set goals and reminders so they can develop healthier drinking habits. The service allows people to track their progress and sends daily reminders for motivation. If you pay annually, the cost is $79, $23 per quarter, or $9 per month.

  • Moderation Management It is an online forum for people who want to cut down on their drinking but definitely not avoid it. The group offers both online and face-to-face meetings where members can share stories, advice and coping strategies. It also maintains an international directory of “moderation-friendly” therapists.

  • Control and Choices is a web-based program that scans people for alcohol use disorder. Provides feedback on your drinking habits and reduction options. The service charges $79 for three months, or $149 per year.


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