New guidance to help family doctors detect and manage high-risk drinking fills an important knowledge gap for both patients and doctors. The authors of the guidance warn against the common practice of prescribing antidepressants, as they can actually increase cravings for alcohol. The guidance consists of 15 recommendations on early detection of alcohol use disorder, withdrawal management, psychological interventions, and community-based programs.
The guidance emphasizes the need for routine screening for alcohol use and provides tips on what to avoid. One of the key recommendations is to rule out problematic alcohol use before prescribing antidepressants, as they can worsen symptoms of alcoholism. The guidance also advises against prescribing antipsychotic medications off-label to treat alcohol addiction, as they can exacerbate symptoms.
The guideline was published in the Canadian Medical Association Journal and was developed by the Canadian Research Initiative on Substance Misuse and the BC Centre on Substance Use with input from a committee of 36 members across the country. The committee included clinicians, academics, and individuals who have experienced alcoholism or are currently struggling with it.
The authors of the guidance hope that it will be endorsed by medical associations across the country. They emphasize that screening for alcohol use can be done in as little as half a minute. Doctors are advised to ask patients how often they have had more than four drinks on one occasion in the past year if they are female, or more than five drinks if they are male. Depending on the patient’s alcohol use, physicians can provide advice on health risks, suggest ways to cut back, or prescribe specific medications for alcohol use disorder. Patients may also be referred to treatment programs based on their level of risk.
Long-term treatment for alcohol use disorder may include cognitive-behavioral therapy, family-based therapy, peer groups, or recovery programs. The authors of the guidance note that the treatment rate for alcohol use disorder in Canada is less than 10%, compared to an estimated 18% in Britain, where a similar guideline was adopted in 2012. They also highlight the need to screen for connections to alcohol use when patients report symptoms such as depression or insomnia, as these can be related to alcoholism.
The guidance is based on evidence and aims to address the failure of institutions to effectively address the morbidity and mortality associated with alcohol use disorder in Canada. The authors stress the importance of training more healthcare providers and talking to patients about alcohol use to ensure proper diagnosis and treatment. The guidance will be available online and webinars will be offered to doctors to support its implementation.
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