Background-Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. The current study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample.

Objective Update the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population. Methods Using whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those who filled a prescription for naltrexone, acamprosate or disulfiram at least once during that period to those who did not fill a prescription for an alcohol use disorder medication. Results Only 1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram). Most prescriptions came from family physicians in urban alcohol use disorder (53.6%) and psychiatrists (22.3%). Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment (OR 2.25; 95% CI 1.83–2.77) or had a mood/anxiety disorder diagnosis vs no diagnosis (OR 2.40, 95% CI 1.98–2.90) in the five years before being diagnosed with alcohol use disorder. Conclusion Despite established evidence for the effectiveness of pharmacotherapy for alcohol use disorder, these medications continue to be profoundly underutilized in Canada.

Background and aims High‐risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol‐related cancers, diabetes, ischemic heart disease (IHD) and mortality between those with and without an indication of alcohol use disorder (AUD). Design Retrospective, population‐based, matched cohort study using data from the Manitoba Population Research Data Repository. Rates were modeled using generalized linear models with either negative binomial distribution or Poisson distribution and a log offset of person‐years to account for each person's time to follow‐up. Setting Manitoba, Canada. Participants Individuals aged ≥ 12 years with a first indication of AUD (index date) between 1 April 1990 and 31 March 2015 were matched to five controls based on age, sex and geographical region at index. This study included 53 410 individuals with AUD and 264 857 matched controls. Measurements Adjusted rate ratios (aRR) and 95% confidence intervals (CI) were determined for each outcome from 5 years prior to and 20 years after AUD detection. Findings Alcohol‐related cancers (aRR = 4.85, 95% CI = 3.88–6.07 and aRR = 1.85, 95% CI = 1.35–2.53 for men and women, respectively), diabetes (aRR = 1.74, 95% CI = 1.50–2.02 and aRR = 2.43, 95% CI = 2.20–2.68) and IHD (aRR = 3.59, 95% CI = 3.31–3.90 and aRR = 2.92, 95% CI = 2.50–3.41) peaked in the 1 year prior to index for those with AUD compared with matched controls. All‐cause mortality (aRR = 3.31, 95% CI = 3.09–3.55 and aRR =3.61, 95% CI = 3.21–4.04) was highest in the year of index and remained higher among cases compared with controls throughout the 20‐year follow‐up. Conclusion People with alcohol use disorder appear to have higher rates of adverse health outcomes in the year before alcohol use disorder recognition, and death at the time of alcohol use disorder recognition, compared with matched controls.

he high prevalence of alcohol consumption in Canada is a contributing risk factor for several chronic disease states. 1-3 According to recent estimates, more than three-quarters of Canadians consume alcohol regularly, with almost 1 in 5 surpassing the level of consumption that puts their health at elevated chronic risk. 4 Alcohol use disorder, a manifestation of at-risk alcohol consumption, is characterized by a pattern of alcohol drinking associated with substantial impairment or distress. 5 For 2012, Statistics Canada reported that the annual prevalence of alcohol use disorder was about 4.7% for men and 1.7% for women. 6 The total costs and harms attributable to alcohol use, including health-related costs, lost workplace productivity and criminal justice costs, are estimated to be nearly $15 billion and are higher for alcohol than for any other substance measured. 7 Many studies have linked alcohol use disorder to increased risk of chronic disease (including liver cirrhosis, cognitive impairment and cancer), impairment of interpersonal relationships and occupational functioning, injury, violence and suicide. 8-11 Despite the high degree of medical and psychosocial comorbidity associated with alcohol use disorder, relatively little is known about patterns of health service use in the general population of people with the disorder. Previous studies have examined hospital stays among "risky drinkers" who did not have a diagnosis of alcohol use disorder, 12 have reported cross-sectional rates of emergency department visits related to alcohol use in small samples of people with diagnosis of the