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Alcohol abuse is on the rise, but doctors too often fail to treat it

NEW JERSEY — Like many people who struggle to control their drinking, Mr Andy Mathisen tried a lot of ways to cut back.

Alcohol abuse is on the rise, but doctors too often fail to treat it

Alcohol abuse can be driven by a complex array of factors, including stress, depression and anxiety, as well as a person’s genetics, family history and socioeconomic circumstances.

NEW JERSEY — Like many people who struggle to control their drinking, Mr Andy Mathisen tried a lot of ways to cut back.

He went through an alcohol detox program, attended Alcoholics Anonymous meetings, and tried using willpower to stop himself from binge drinking.

But this past winter, with the stress of the pandemic increasingly weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.

Frustrated, and feeling that his health and future were 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 necessarily giving up alcohol entirely.

After signing up for the service in March, he received coaching and was given a prescription for naltrexone, a medication that diminishes cravings and blunts the buzz from alcohol.

The program accepts some insurance and charges US$350 (S$480) a month for a one-year commitment for people who pay out of pocket. Since he started using it, Mr Mathisen has reduced his drinking substantially, limiting himself to just one or two drinks a couple days a week.

“My alcohol consumption has dropped tremendously,” said Mr Mathisen, 70, a retired telecommunications manager who lives in central New Jersey. “It’s no longer controlling my life.”

Mr Mathisen is one of the roughly 17 million Americans who grapple with alcoholism, the colloquial term for alcohol use disorder, a problem that was exacerbated this past year as the pandemic pushed many anxious and isolated people to drink to excess.

The National Institutes of Health defines the disorder as “a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences”.

Yet despite how prevalent it is, most people who have the disorder do not receive treatment for it, even when they disclose their drinking problem to their primary care doctor or another health care professional.

Last month, a US nationwide study by researchers at the Washington University School of Medicine in St. Louis found that about 80 per cent of people who met the criteria for alcohol use disorder had visited a doctor, hospital or medical clinic for a variety of reasons in the previous year.

Roughly 70 per cent of those people were asked about their alcohol intake. Yet just one in 10 were encouraged to cut back on their drinking by a health professional, and only six per cent received any form of treatment.

Alcohol abuse can be driven by a complex array of factors, including stress, depression and anxiety, as well as a person’s genetics, family history and socioeconomic circumstances.

Many people kick their heavy drinking habit on their own or through self-help programs like Alcoholics Anonymous or Smart Recovery. But relapse rates are notoriously high. Research suggests that among all the people with alcohol use disorder who try to quit drinking every year, just 25 per cent are able to successfully reduce their alcohol intake long-term.

While there is no silver bullet for alcohol use disorder, several medications have been approved to treat it, including pills like acamprosate and disulfiram, as well as oral and injectable forms of naltrexone.

These medications can blunt cravings and reduce the urge to drink, making it easier for people to quit or cut back when combined with behavioral interventions like therapy.

Yet despite their effectiveness, physicians rarely prescribe the drugs, even for people who are most likely to benefit from them, in part because many doctors are not trained to deal with addiction or educated on the medications approved to treat it.

In a study published last month, scientists at the NIH found that just 1.6 per cent of the millions of Americans with alcohol use disorder had been prescribed a medication to help them control their drinking.

“These are potentially lifesaving medications, and what we found is that even among people with a diagnosable alcohol use disorder the rate at which they are used is extremely low,” said Dr Wilson Compton, an author of the study and deputy director of the National Institute on Drug Abuse.

The implications of this are substantial. Alcohol is one of the most common forms of substance abuse and a leading cause of preventable deaths and disease, killing almost 100,000 Americans annually and contributing to millions of cancers, car accidents, heart attacks and other ailments.

It is also a significant cause of workplace accidents and lost work productivity, as well as a driver of frayed family and personal relationships. Yet for a variety of reasons, people who need treatment rarely get it from their physicians.

Some doctors buy into a stereotype that people who struggle with alcohol are difficult patients with an intractable condition. Many patients who sign up for services like Ria Health do so after having been turned away by doctors, said Dr John Mendelson, a professor of clinical medicine at the University of California, San Francisco, and Ria Health’s chief medical officer.

“We have patients who come to us because they’ve been fired by their doctors,” he added.

But another reason for the low rates of treatment is that problem drinkers are often in denial, said Compton at the National Institute on Drug Abuse.

Studies show that most people who meet the criteria for alcohol use disorder do not feel that they need treatment for it, even when they acknowledge having all the hallmarks of the condition, like trying to cut back on alcohol to no avail, experiencing strong cravings, and continuing to drink despite it causing health and relationship problems.

“People are perfectly willing to tell you about their symptoms and the difficulties they face,” Dr Compton said. “But then if you say, ‘Do you think you need treatment?’ they will say they do not. There’s a blind spot when it comes to putting those pieces together.”

This article originally appeared in The New York Times.

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health alcohol addiction alcoholism

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