Academic journal article Alcohol Research

Gaps in Clinical Prevention and Treatment for Alcohol Use Disorders: Costs, Consequences, and Strategies

Academic journal article Alcohol Research

Gaps in Clinical Prevention and Treatment for Alcohol Use Disorders: Costs, Consequences, and Strategies

Article excerpt

Heavy drinking causes significant morbidity, premature mortality, and other social and economic burdens on society, prompting numerous prevention and treatment efforts to avoid or ameliorate the prevalence of heavy drinking and its consequences. However, the impact on public health of current selective (i.e., clinical) prevention and treatment strategies is unclear. Screening and brief counseling for at-risk drinkers in ambulatory primary care has the strongest evidence for efficacy, and some evidence indicates this approach is cost-effective and reduces excess morbidity and dysfunction. Widespread implementation of screening and brief counseling of nondependent heavy drinkers outside of the medical context has the potential to have a large public health impact. For people with functional dependence, no appropriate treatment and prevention approaches currently exist, although such strategies might be able to prevent or reduce the morbidity and other harmful consequences associated with the condition before its eventual natural resolution. For people with alcohol use disorders, particularly severe and recurrent dependence, treatment studies have shown improvement in the short term. However, there is no compelling evidence that treatment of alcohol use disorders has resulted in reductions in overall disease burden. More research is needed on ways to address functional alcohol dependence as well as severe and recurrent alcohol dependence. kEY WoRDS: Alcohol use, abuse, and dependence; heavy drinking; alcohol use disorders (AUDs); alcohol-related problems; alcohol burden; burden of disease; morbidity; mortality; prevention; treatment; prevention strategy; treatment strategy; screening and brief intervention; primary care; cost-effectiveness of AoD health services

Heavy drinking takes a high toll on society. Other articles in this issue summarize the disease burden and eco- nomic cost to society attributable to alcohol use, which provide a powerful incentive to develop and implement ways to reduce them. The focus of this article is on the role of selective (i.e., clinical) prevention and treatment approaches for heavy drinkers and people with alcohol use disorders (AUDs) in reducing the burden associated with excessive alcohol use. As used here, selective, or clinical, prevention refers to strategies targeted at individuals at higher risk of experiencing adverse alcohol effects, such as screening and brief counseling of heavy drinkers in health care settings or internet-based screening and advice provided to college stu- dents. The term "treatment" refers to services for alcohol dependence provided by a professional, such as a counselor, social worker, nurse, psychologist, or physician. Community peer-led support groups such as Alcoholics Anonymous are considered to be distinct from professional treatment ser- vices, much like a diabetes support group would be distin- guished from endocrinology services. The article focuses on the following three questions: (1) Can selective prevention and treatment reduce the disease burden attributable to heavy drinking? (2) Are some treatment approaches more cost-effective than others? (3) Do gaps exist in the current continuum of care? After addressing these issues, the review suggests research priorities to help close existing gaps and reduce the burden of disease.

Selective Prevention and treatment: Effectiveness, Cost-Effectiveness, and Disease Burden

Screening and brief advice for at-risk (i.e., nondependent) drinkers, commonly known as screening and brief interven- tion (SBI), is effective at reducing drinking for a year or more and in many studies also has been shown to reduce alcohol-related harms, such as motor-vehicle crashes and driving violations. Its efficacy is supported by numerous randomized controlled trials and multiple meta-analyses; as a result, the U.S. Prevention Task Force has listed it as a Type B recommendation for medical prevention services (Babor et al. …

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