With 178,000 Annual Alcohol-Related Deaths, It’s Time to Standardize Care

By Jeff Harris, Vice President & General Manager, Addiction

Each April, we acknowledge Alcohol Awareness Month in the United States. For those living with Alcohol Use Disorder (AUD), awareness is a daily reality. The impact and reach of the disease are substantial. Over 28 million adults in the U.S. live with AUD.¹ In 2021, approximately 178,000 deaths were linked to excessive alcohol use, a 29% increase over the previous 5 years.²  Moreover, the chronic conditions potentially attributable to excessive alcohol use are broad, including liver disease, heart disease, and cancer among others.³

While the prevalence, impact, and biology of AUD are well understood, adoption of best practices for screening, assessment and treatment still lags behind evidence-based standards. In a recent American Journal of Managed Care® roundtable discussion sponsored by Alkermes, healthcare providers – including emergency medicine, psychiatry, nursing, behavioral health specialists and others – talked about their professional experiences with both screening and treatment for AUD.⁴  

While they agreed that screening is a vital part of a patient’s healthcare experience, the group recognized several challenges to more comprehensive assessments for AUD that are critical for helping move patients towards treatment. For example, the providers discussed at length the social stigmas associated with both overuse and abstinence. Because alcohol is legal and largely considered socially acceptable, people may feel they can’t or don’t know how to ask for help, or that their relationship with alcohol isn’t problematic.

If patients are hesitant to talk about their alcohol use or ask for help, the importance of formal screening comes more sharply into focus. Hospital emergency departments (ED) are a common setting in which AUD is identified, but detection of AUD or other substance use disorders (SUDs) in primary care before it progresses to a moderate or severe stage would be ideal, noted one participant.⁴ There are, therefore, opportunities for the U.S. healthcare system, as a whole, to be more diligent and standardized about screening beyond just visits to the emergency department.

The U.S. Preventive Services Task Force (USPSTF) recommends alcohol screenings in primary care.⁵  The ED is not ideal for treatment, so working to improve screening in primary care settings is good for patients. However, there is research suggesting that screening for excessive alcohol use is happening infrequently in primary care practices. In fact, an analysis of over 19,000 adult patient visits to a primary care physician, collected during the 2014-2016 National Ambulatory Medical Care Survey (NAMCS), showed that alcohol screening using an approved tool happened only 2.6% of the time.⁶  

To meet the objective of increased screening in the primary care setting, there are validated pathways for screening and treatment. AUD is diagnosed by a healthcare professional using criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, commonly referred to as the DSM-5.⁷  The Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach is recommended in primary care offices, EDs, and across clinical settings for early intervention.⁸  

Once diagnosed, there are evidence-based treatment options for AUD, which include psychosocial support and medication. In response to observed increases in alcohol-associated liver disease (ALD), related to heavier alcohol use across the general population, the American College of Gastroenterology recently issued updated recommendations for overcoming barriers to treatment.⁹  Their guidelines reference clinical support such as screenings, motivational interviewing, 12-step facilitation programs, and cognitive behavioral therapy, and advise that medication-assisted therapies are considered effective for patients with AUD. Medication-assisted treatment (MAT) joined with counseling and behavioral services may help those living with SUDs to maintain recovery.¹⁰

At Alkermes, we are committed to making a difference in the lives of people living with SUDs, including AUD. Our voice and advocacy, along with the voices of experts in the field, can help us build a healthcare system that views addiction not as a moral failing, but as a treatable biological condition. This Alcohol Awareness Month offers us time to reflect on how people living with AUD are supported in their recovery journeys and to advocate for a more responsive healthcare system, which recognizes and embraces the importance of effective screening, diagnosis and treatment for AUD.   

References:

¹Substance Abuse and Mental Health Services Administration (SAMHSA). 2021 National Survey of Drug Use and Health (NSDUH). https://shorturl.at/sAQU2 

²Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2020-2021 Alcohol-Attributable Deaths Due to Excessive Alcohol Use. https://shorturl.at/cktE2 

³Centers for Disease Control and Prevention (CDC). Alcohol and Public Health. Deaths from Excessive Alcohol Use in the United States. https://shorturl.at/cmBI9 

⁴Improving Awareness and Access for Treatment of Alcohol Use Disorder. Am J Manag Care. 2023 Nov.

⁵U.S. Preventive Services Task Force (USPSTF). Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. 2018 Nov 13. https://shorturl.at/ehOST 

⁶Chatterton B, Agnoli A, Bimla Schwarz E, and Fenton JJ. Alcohol Screening During US Primary Care Visits, 2014-2016. J Gen Intern Med. 2022 Nov; 37(15): 3848-3852.

⁷Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. American Psychiatric Association. Alcohol-Related Disorders: Alcohol Use Disorder.

⁸Substance Abuse and Mental Health Services Administration (SAMHSA). Screening, Brief Intervention, and Referral to Treatment (SBIRT). https://tinyurl.com/3umvzkxp 

⁹Loretta LJ, Singal AK, Bataller R, Wong RJ, Sauer BG, Terrault NA, and Shah VH. ACG Clinical Guideline: Alcohol-Associated Liver Disease. Am J Gastroenterol. 2024 Jan; 119(1): 30-54.

¹⁰Substance Abuse and Mental Health Services Administration (SAMHSA). Medications for Substance Use Disorders. https://tinyurl.com/yc2588ya 

Last updated: April 2024

Original article appeared on LinkedIn.com. Republished with permission.