Hitting the bottle less hard: can it reduce harm?

From a recent European survey, it looks as if around 2% of women and 5% of men are dependent on alcohol. This amounts to around eleven million people. And alcohol dependence accounts for one in twelve premature deaths.

Evidence suggests that general practitioners (GPs) can identify the problem at least as well as standard tools such as CIDI (the Composite International Diagnostic Interview), Professor Jürgen Rehm (University of Toronto, Canada, and Technical University of Dresden, Germany) told the meeting. Yet GPs tend not to start treatment themselves, and they don’t refer patients for specialised care. This is perhaps because they view alcohol dependence as a highly stigmatised condition.

Such reluctance is unfortunate since early intervention can reduce the extent to which patients with alcohol dependency develop comorbidities and need to access specialist care both for addiction-related issues and for more general health problems. GPs might do better to consider alcohol dependence in the same way they consider hypertension. They would start with advice on modifying lifestyle and, if that was not successful, they would move on to consider treatment – which might include pharmacotherapy. Primary care is the key to managing this problem, Profesor Rehm argued.

Keeping patients on treatment is not easy, but persistence with therapy is associated with improved outcomes, according to data presented by Professor Henry Kanzler (University of Pennsylvania, USA). The first step, though, is to get alcohol-dependent people to engage with the healthcare system.  

Several barriers prevent people seeking treatment. Some of those with alcohol dependence think they can get away with a few more years of highly-risky hitting the bottle. Some don’t want the associated stigma. In the USA, for example, many lack health insurance and cannot afford the cost. But others would like help in cutting down their alcohol consumption though they are not, or not yet, prepared to consider abstinence.

Because of the steep dose-response curve relating intake to harm, any fall in consumption among those drinking at high levels has considerable benefit. For this reason, a reduction strategy should be part of our armamentarium, Dr Julia Sinclair (Wessex Alcohol Lead, University of Southampton, UK) suggested. In addition, patients may find cutting down is a step to regaining control, and some move on to thinking that what they really need is to quit altogether.