New strategies have been released, designed to aid family physicians in identifying and managing high-risk drinking. This addresses a significant knowledge gap that prevails not just among patients, but doctors as well. In fact, it highlights the warning that prescribing antidepressants, a current common practice, can lead to an increase in alcohol cravings.
The counsel consists of 15 directives focusing on the early detection of alcohol use disorders. It addresses the management of withdrawal symptoms, recommends psychological interventions, and outlines community-based programs. An essential part of the advice also includes routine screening for alcohol consumption, suggesting preventive measures like refraining from prescribing antidepressants without first eliminating problematic alcohol use, given that selective serotonin reuptake inhibitors (SSRIs) can amplify symptoms of alcoholism.
Jurgen Rehm, a key member of the guideline crafting committee, points out the common practice by Canadian doctors of prescribing SSRIs. He emphasizes that this is not an advisable practice as existing literature greatly supports the benefit of medications that are specifically intended for treating alcohol use disorders, which are alarmingly underutilized.
The guidance, after its publication in the Canadian Medical Association Journal, now serves as a set of principles developed collaboratively by the Canadian Research Initiative on Substance Misuse (CRISM) and the BC Centre on Substance Use (BCCSU). It is the result of an inclusive process involving 36 members nationwide including clinicians, academics, and individuals who have personally battled alcoholism or are currently in the fight.
The committee harbors hopes of widespread endorsement by medical associations across the country. Doctors are encouraged to ask patients about their alcohol consumption: for women, more than four drinks on one occasion within the past year, and for men, more than five. Depending on individual responses, potential advice could range from health risks counselling, suggestions to reduce alcohol intake, to prescribing specific medications for alcohol use disorder. Arrangements could also be facilitated for treatment programs inside or outside of hospital based on the risk of potential complications like seizures.
Proposed long-term treatments might also encompass cognitive behavioral or family-based therapy, peer groups, or recovery programs. Current treatment rates for alcohol use disorders in Canada stand at less than 10%, in stark contrast to the 18% estimate in Britain, where a similar guideline was incorporated in 2012.
In several provinces, less than 2% of patients receive prescribed medications like naltrexone or acamprosate, specifically designed for alcohol use disorders and recommended by the guidelines. Without sufficient inquiries regarding alcohol overuse, patients reporting symptoms like depression or insomnia often receive prescriptions for SSRIs.
Amanda Hintzen narrates her personal struggle with alcoholism, having sought help from a family physician amid a downward spiral augmented by excessive daily drinking. Instead of resources to deal with her addiction, she left with three prescriptions addressing associated symptoms, while bypassing the severity of her alcohol dependency. The critical gap in handling alcohol use disorders becomes painfully evident from instances like Hintzen’s, necessitating immediate rectification.
The dimensions of informed alcohol treatment stretch beyond managing the disorder to effectively addressing high levels of disease and deaths resulting from it. So, as the guidelines highlight, taking the time to delve into a patient’s alcohol consumption patterns can untangle and address the root cause of conditions like depression, insomnia, anxiety, and high blood pressure, rather than solely treating their symptoms.
In the wake of the updated guidance from the Canadian Centre on Substance Use and Addiction (CCSA) regarding increased health risks associated with more than two standard drinks per week, these guidelines come as a critical addition. Funded by Health Canada, they will be made available online, further supplemented by webinars for doctors.
