Alcohol abuse is increasing. Here’s why doctors failed to treat it.
Like many people who struggle to control their drinking, Andy Matissen has tried many ways to cut back on their consumption.
He attended Alcoholics Anonymous meetings, went to a rehab center for alcohol abuse, and tried to use willpower to stop himself from drinking too much. But nothing seems to work. Last year, with the stress of the pandemic weighing on him, he found himself craving a beer every morning, drinking in his car and polishing two liters of scotch every week.
Frustrated, and feeling that his health and future were in a downward spiral, Mr. Mathiesen turned to the Internet and discovered Ria Health, a telehealth program that uses online training and medication to help people curb their drinking without giving up alcohol completely.
After signing up for the service in March, he received training and received a prescription for naltrexone, a drug that reduces cravings for alcohol. The program accepts some insurance and charges $350 per month for a one-year commitment for people who pay out of their own pocket. Since he started using it, Mr. Matessen has reduced his drinking significantly, limiting himself to just one or two drinks on two days a week.
“My alcohol consumption has dropped dramatically,” said Matissen, 70, a retired communications manager who lives in central New Jersey. “He no longer controls my life.”
Mr. Matessen is one of the Nearly 17 million Americans who grapple with alcoholism, the slang term for alcohol use disorder, a problem that has been It got worse in the last year The pandemic has pushed many anxious and isolated people to binge drinking. The The National Institutes of Health defines the disorder as “a medical condition characterized by an impaired ability to stop or control alcohol use despite negative social, occupational, or health consequences.” However, despite its prevalence, most people with this disorder do not receive treatment for it, even when they disclose their drinking problem to their primary care doctor or other health care professional.
Last month , national study Researchers at Washington University School of Medicine in St. Louis found that about 80 percent 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. Nearly 70 percent of these people were asked about their alcohol intake. However, only one in 10 was encouraged to reduce their drinking by a health professional, and only 6 percent received any form of treatment.
Alcohol abuse can be caused by a complex of factors, including stress, depression, and anxiety, as well as a person’s genetics, family history, and socioeconomic circumstances. Many people break their excessive drinking habit on their own or through self-help programs such as Alcoholics Anonymous or Smart Recovery. But relapse rates are remarkably high. Research indicates that Of all people with alcohol use disorder who try to quit drinking each year, only 25 percent are able to successfully reduce their long-term alcohol intake.
Although there is no panacea for alcohol use disorder, several medications have been approved to treat it, including pills such as acamprosate and disulfiram, as well as oral and injectable forms of naltrexone. These drugs can Intense cravings and reduced cravings To drink, which makes it easier for people to quit or reduce smoking when combined with behavioral interventions such as therapy.
However, despite their effectiveness, doctors rarely prescribe drugs, even to people who are most likely to benefit from them, in part because many doctors are not trained in dealing with addiction or educated about the drugs approved to treat it. In a study published last month,Scientists at the National Institutes of Health found that only 1.6 percent of the millions of Americans with alcohol use disorder have been prescribed medication to help them control their drinking. Dr. Wilson Compton, study author and deputy director of the National Institute on Drug Abuse said.
The implications of this are great. Alcohol is one of the most common forms of drug use and a leading cause of preventable death, disease, and homicide. Nearly 100,000 Americans annually and contribute to millions of cancers, car accidents, heart attacks, and other diseases. It is also An important cause of accidents in the workplace And lost work productivity, as well Tense family driver and personal relationships. However, for a variety of reasons, people who need treatment rarely get it from their doctors.
Some doctors buy into the stereotype that people with alcohol are difficult patients with an incurable condition. Many patients who sign up for services like Ria Health do so after being rejected by doctors, said Dr. John Mendelson, professor of clinical medicine at the University of California, San Francisco, and chief medical officer of Ria Health. “We have patients coming to us because their doctors were fired,” he added.
In other cases, clinicians without a background in addiction may be concerned that they do not have the expertise to treat alcohol dependence. Or they may feel uncomfortable prescribing medications for them, although doing so doesn’t require special training, said Dr. Carrie Mintz, associate professor of psychiatry at the University of Washington and co-author of the study last month that looked at nationwide treatment rates.
The result is that a lot of patients end up being referred to mental health experts or sent to rehabilitation centers and 12-step programs like AA
“There is a stigma associated with substance use disorders, and their treatment has historically been outside the health care system,” said Dr. Mintz. “We think that these extra steps of having to refer people for treatment is a hindrance. We argue that treatment should take place there at the point of care when people are in the hospital or clinic.”
Dr Compton of the National Institute on Drug Abuse said another reason for low treatment rates is that heavy drinkers are often in denial. Studies show Most people who meet the criteria for alcohol use disorder do not feel they need treatment, even when they acknowledge there is everything Status fingerprintssuch as trying to cut back on alcohol, cravings, and continuing to drink even though it causes health and relationship problems.
“People are very willing to tell you about their symptoms and the difficulties they are having,” Dr. Compton said. “But then if you say, ‘Do you think you need treatment? “They’ll say they don’t. There’s a blind spot when it comes to putting those pieces together.”
Studies show that the main barrier for people seeking treatment is that they believe abstinence is their only option. This perception is driven by the prevalence and long history of 12-step programs such as AA that advocate abstinence as the only solution to alcoholism. For some people with serious drinking problems, this may be necessary. But studies show that people with milder forms of alcohol use disorder can improve their mental health And the Quality of life, as well as blood pressure and liver health and other aspects of their physical health, by reducing their alcohol intake without giving up alcohol completely. However, the idea that the only option is to quit cold turkey could prevent people from seeking treatment.
“People think that abstinence is the only way — and in fact not the only way,” said Katie Witkiewicz, director of the Laboratory of Addictive Behaviors and Quantitative Research at the University of New Mexico and past president of the Society for Addiction Psychology. . “We found strong improvements in health and performance when people reduced their drinking, even if they did not regress from abstaining from alcohol.”
For people who are concerned about their alcohol intake, Dr. Witkiewitz recommends keeping track of exactly how much you drink and then setting goals according to how much you want to reduce your intake. If you normally consume 21 drinks a week, for example, cutting out just 5 to 10 drinks — on your own, with the help of a therapist or medication — can make a big difference, Dr. Witkiewitz said. “Even this level of reduction would be associated with improvements in cardiovascular function, blood pressure, liver function, sleep quality, and overall mental health,” she added.
Here are some tools that can help.
Ria Health It is a telehealth program that provides treatment for people with alcohol use disorder. It provides medical advice, online training, medication, and other tools to help people reduce or abstain from alcohol if they want to. It costs $350 per month for the annual program, is cheaper than most rehabilitation programs, and accepts some form of health insurance.
The National Institute on Alcohol Abuse and Addiction has a free website It’s called rethinking drinking It can help you find doctors, therapists, support groups, and other ways to get treatment for your drinking problem.
coach cut It is a popular app that helps people keep track of their alcohol intake and set goals and reminders so they can develop healthy drinking habits. The service allows people to track their progress and send daily motivational reminders. The cost is $79 if you pay annually, $23 per quarter, or $9 per month.
moderation management It is an online forum for people who want to reduce their drinking but not necessarily abstain. The group offers meetings, both online and in person, where members can share stories, tips, and coping strategies. It also maintains an international directory of “moderate-friendly” healers.
Choice and choices It is a web-based program that screens people for alcohol use disorder. Provides feedback on drinking habits and cutting options. Service fee of $79 for three months or $149 per year.