Newswise — Rates of treatment for alcohol use disorder (AUD) in the US are alarmingly low, according to a large analysis reported in Alcoholism: Clinical and Experimental Research. An estimated 93,000 people in the US die from alcohol-related causes each year, and mortality associated with AUD has been increasing. Effective treatments for AUD already exist, including evidence-based psychotherapy interventions, mutual aid approaches, and three FDA-approved medications (naltrexone, acamprosate, and disulfiram). However, previous research has indicated that fewer than one in ten people with AUD receive treatment, highlighting the need for a greater understanding of gaps in care and of where interventions can be most appropriately targeted. Researchers at Washington University School of Medicine have now used a ‘cascade of care framework’ to identify these gaps, by tracking the proportion of the AUD population engaged in each step of the care continuum from diagnosis onwards.
The research team used nationally representative data from the National Survey on Drug Use and Health, an annual survey in which thousands of people from across the US are asked questions on their substance use, healthcare utilization and experiences, and treatment. Using data from the 2015 to 2019 surveys, the researchers first evaluated the prevalence of AUD among the adult population according to standard diagnostic criteria. Next, they determined the proportion of individuals with AUD who within the previous year had met the following steps in the cascade of care beyond diagnosis: 1. Had accessed health care; 2. Were screened by a healthcare provider about their alcohol use, via one or more simple questions (example: ‘How much do you drink’?); 3. Had been advised by a healthcare provider to cut down on drinking (this brief approach can itself be sufficient intervention for those with milder forms of AUD); 4. Had received or were offered additional information on alcohol use and treatment for problem drinking; and 5. Had received treatment (or counseling) for alcohol use.
Of the 214,505 people surveyed, 7.8% met the criteria AUD. The cascade of care analysis showed that around four-fifths (81%) of those with AUD had utilized health care within the previous year, and most (70%) had also been screened about alcohol use. However, only a minority of people with AUD had received the subsequent steps of care. Just 12% reported being advised to cut down on drinking, 5% being offered more information on treatment, and 6% having actually received treatment. Similar patterns were observed regardless of the severity of the AUD diagnosis.
The findings highlight that individuals with AUD remain woefully undertreated, with only a small minority receiving treatment (of any type) for their condition. Even among people with severe AUD, only 21% reported receiving any AUD treatment within the past 12 months. The low prevalence of AUD treatment compares poorly with treatment rates for other chronic diseases. For example, recent cascade of care models indicate that two-thirds of people with HIV, and 94% with diabetes, receive treatment for their illness.
The data further highlight that the lack of treatment for AUD does not result from a lack of access to health care or a lack of screening for alcohol use. Rather, the researchers suggest that the implementation gap between screening treatment partly reflects the historic separation of AUD treatment from mainstream healthcare settings, with treatment typically delivered in specialist care settings following referral. They suggest instead that mainstream settings such as primary care – which most patients are already accessing – should be more widely used for AUD assessment and treatment delivery, with referral to further specialist care where needed. This approach would increase rates of treatment for AUD and may enhance long-term outcomes among this high-risk population.
A cascade of care for alcohol use disorder: Using 2015-2019 national survey on drug use and health data to identify gaps in past 12-month care
C.M. Mintz, S. M. Hartz, S. L. Fisher, A. T. Ramsey, E. H. Geng, R. A. Grucza, L. J. Bierut (pages xxx)
ACER-20-4670.R2
Journal Link: Alcoholism: Clinical and Experimental Research
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