Alcoholism TX Not a Primary Care Concern

By McNamara, Damian | Clinical Psychiatry News, November 2005 | Go to article overview

Alcoholism TX Not a Primary Care Concern


McNamara, Damian, Clinical Psychiatry News


Primary care physicians are not very confident that medications to treat people with alcoholism will be effective: Only 26% of 300 general practitioners and internists taking an online survey thought medication would be effective or very effective.

The survey results also showed that many physicians do not address risk with patients. "Exactly half of doctors do not ask their patients about alcohol use," Allan Rivlin said during a teleconference on alcoholism sponsored by the Community Anti-Drug Coalitions of America.

The 50% of physicians who inquire about alcohol consumption only do so half of the time or less. Reasons for this include a lack of resources (48%), patient denial (41%), and a belief that alcoholism is not their area of expertise (24%).

"The big clinical picture is there is a large population in this country with alcohol use disorders--18 million--and the majority never receive any help," said David Kessler, M.D., dean of the school of medicine at the University of California, San Francisco, and former commissioner of the Food and Drug Administration.

Physicians can make a difference by asking patients directly about drinking. They can also help if they delay alcohol use in children and adolescents. "The average age when a young person first tries alcohol is 11-13 years. The likelihood of alcohol use and dependence can be reduced by 5% for each year onset of alcohol use is delayed," Dr. Kessler said.

Primary care physicians who lack awareness and experience with medications for alcohol treatment are limiting patients' ability to recover, said Mr. Rivlin, senior vice president of Peter D. Hart Research Associates, the firm that conducted the online survey.

"People are preoccupied, anxious, overwhelmed, desperate. These medications give you a chance to bring them back into the fray," said Drew Pinsky, M.D., medical director of the department of chemical dependency services at Las Encinas Hospital in Pasadena, Calif.

Despite the availability of medications, only 139,000 people in the United States are prescribed a drug to treat alcohol dependence or abuse, according to Alan Leshner, Ph.D., chief executive officer of the American Association for the Advancement of Science in Washington.

Just over half of physicians, 51%, reported prescribing disulfiram (Antabuse) at some point, and 26% said they currently prescribe the agent. A total of 26% have experience with naltrexone (Revia), and 15% have experience with the newest medication, acamprosate (Campral).

"Those who do have experience prescribing newer medications are much more likely to believe they are effective," Mr. …

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