Research-Based Approaches to Treating Alcohol Use in Primary Care

When it comes to generating high-quality evidence applicable to clinical care, the alcohol field has lagged behind other medical-scientific fields, according to Dr Richard Saitz, a recent presenter at Yale University Medical School. Dr Saitz is Professor of Medicine and Epidemiology and Director of the Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, at Boston University Schools of Medicine and Public Health.

Take-home points:

1. MEDICATIONS

•Placebo-controlled clinical trials demonstrate that medications-in particular, long-acting benzodiazepines-can treat withdrawal symptoms and prevent morbidity and mortality. They can be implemented efficiently with symptom-triggered therapy. When implemented widely though, caution is required because efficacy can be lost and harms introduced in the process.

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2. INTEGRATIVE CARE

•Most patients with alcohol dependence-even when physicians recognize the symptoms-receive no proven effective treatments. Integrating primary medical and alcoholism care may be a solution.

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3. STRATEGIES

•A number of strategies are known to be effective and should be implemented in primary care settings:

-screen to identify the full spectrum of unhealthy use
-counsel briefly and refer to specialists when appropriate
-initiate proper pharmacotherapies

If for no other reason, these strategies might improve the effects of heavy drinking on medication adherence and clinical outcomes of medical and other psychiatric conditions

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4. CAUTION

•Screening and brief interventions have modest efficacy at best. When implemented in the real world, screening/intervention might not be effective at all

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5. NEXT STEPS

•Discover more effective treatments. In the meantime, physicians should focus on implementing what clinical trials have shown to be reasonably effective:

-alcohol withdrawal treatments
-pharmacotherapy for dependence
-screening and brief intervention
-integrated care