Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

Tuithof, Marlous; Have, Margreet ten; Brink, Wim van den; Vollebergh, Wilma; Graaf, Ron de

doi:10.1159/000446822

Cited by 51 publications

(38 citation statements)

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“…However, in patients with a high or VH drinking level, this treatment gap seems to be somewhat smaller as 24 to 49 percent of these subjects in a Dutch general population sample received treatment for their AUD (Tuithof et al . ).…”

Section: Current Treatment Options For Alcohol Dependencementioning

confidence: 99%

Efficacy and safety of sodium oxybate in alcohol‐dependent patients with a very high drinking risk level

et al. 2018

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Medication development for alcohol relapse prevention or reduction of consumption is highly challenging due to methodological issues of pharmacotherapy trials. Existing approved medications are only modestly effective with many patients failing to benefit from these therapies. Therefore, there is a pressing need for other effective treatments with a different mechanism of action, especially for patients with very high (VH) drinking risk levels (DRL) because this is the most severely affected population of alcohol use disorder patients. Life expectancy of alcohol-dependent patients with a VH DRL is reduced by 22 years compared with the general population and approximately 90 000 alcohol-dependent subjects with a VH DRL die prematurely each year in the EU (Rehm et al. ). A promising new medication for this population is sodium oxybate, a compound that acts on GABA receptors and extrasynaptic GABA receptors resulting in alcohol-mimetic effects. In this article, a European expert group of alcohol researchers and clinicians summarizes data (a) from published trials, (b) from two new-as yet unpublished-large clinical trials (GATE 2 (n = 314) and SMO032 (n = 496), (c) from post hoc subgroup analyses of patients with different WHO-defined DRLs and (d) from multiple meta-analyses. These data provide convergent evidence that sodium oxybate is effective especially in a subgroup of alcohol-dependent patients with VH DRLs. Depending on the study, abstinence rates are increased up to 34 percent compared with placebo with risk ratios up to 6.8 in favor of sodium oxybate treatment. These convergent data are supported by the clinical use of sodium oxybate in Austria and Italy for more than 25 years. Sodium oxybate is the sodium salt of γ-hydroxybutyric acid that is also used as a recreational (street) drug suggestive of abuse potential. However, a pharmacovigilance database of more than 260 000 alcohol-dependent patients treated with sodium oxybate reported very few adverse side effects and only few cases of abuse. We therefore conclude that sodium oxybate is an effective, well-tolerated and safe treatment for withdrawal and relapse prevention treatment, especially in alcohol-dependent patients with VH DRL.

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Section: Current Treatment Options For Alcohol Dependencementioning

confidence: 99%

Efficacy and safety of sodium oxybate in alcohol‐dependent patients with a very high drinking risk level

et al. 2018

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“…When individuals who meet criteria for AD are asked why they do not want to receive treatment for an alcohol problem, surveys have found nearly half of all individuals with AD not seeking treatment because they do not want to give up drinking completely [30,31]. Other research has suggested that the majority of people with DSM-5 AUD who do not seek treatment are less severe and, thus, these individuals do not consider taking treatment [32]. …”

Section: Introductionmentioning

confidence: 99%

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

2017

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Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept “intermediate harm reduction” (European Medicines Agency) or “low-risk drinking limits” (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.

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“…However, SUD cases with comorbid mental disorders have worse clinical presentation and outcomes [13], and are more likely to report unmet treatment needs [42,49]. Moreover, longitudinal studies show that people with SUDs who do not access treatment have, on average, less severe disorders and more favourable outcomes than treatment users, suggesting that many people appropriately self-select for treatment [50,51]. Further examination of the relationship between clinical characteristics of SUDs (e.g.…”

Section: Discussionmentioning

confidence: 99%

Cross‐national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys

et al. 2019

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Aims To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. Design Cross-sectional, representative household surveys. Setting Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. Participants A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). Measurements Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socioeconomic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. Findings Of respondents with pastyear SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socioeconomic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in highthan low-/middle-income countries. Conclusions Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.

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Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

Cited by 51 publications

References 47 publications

Efficacy and safety of sodium oxybate in alcohol‐dependent patients with a very high drinking risk level

Efficacy and safety of sodium oxybate in alcohol‐dependent patients with a very high drinking risk level

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

Cross‐national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys

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