TOPLINE:
New Canadian guidelines for the management of high-risk drinking and alcohol use disorder (AUD) include 15 recommendations on screening, diagnosis, withdrawal management, and ongoing treatment including psychosocial interventions, drug therapies, and community-based programs.
METHODOLOGY:
- The Canadian Research Initiative in Substance Misuse convened a 36-member committee of clinicians, researchers, people with personal experience of alcohol use, and Indigenous or Métis individuals to develop the guidelines, using the Appraisal of Guidelines for Research and Evaluation Instrument.
- Risk assessment was based on Alcohol Use Disorders Identification Test-Consumption scores.
- The definition of AUD was based on patients experiencing “clinically significant impairment or distress” from their alcohol use, with severity being mild, moderate, or severe.
TAKEAWAY:
- All adult and youth patients at moderate or high risk for AUD should be screened annually for alcohol use, and those screening positive should receive a diagnostic interview for AUD and an individualized treatment plan.
- Assessment of severe alcohol withdrawal complications should include clinical parameters such as past seizures or delirium tremens and the Prediction of Alcohol Withdrawal Severity Scale, with treatment including nonbenzodiazepine medications for low-risk patients and a short-term benzodiazepine prescription for high-risk patients, ideally in an inpatient setting.
- All patients with AUD should be referred for psychosocial treatment, and those with moderate to severe AUD should be offered naltrexone, acamprosate, topiramate, or gabapentin, depending on contraindications and effectiveness.
- Antipsychotics or SSRI antidepressants have little benefit and may worsen outcomes and should not be prescribed for AUD.
IN PRACTICE:
The authors noted that more than half of people aged 15 years or older in Canada drink more than the recommended amount, and about 18% meet the definition for AUD. “The aim of this guideline is to support primary care providers and services to offer more effective treatments routinely to patients with AUD as the standard of practice, with resulting improvements in health as well as potential for considerable cost savings in health and social systems,” the investigators write. They also note that policy makers can substantially improve standards of care by promoting adoption of the guideline and its recommendations.
SOURCE:
The article was written by Evan Wood, MD, PhD, professor of medicine, University of British Columbia, Vancouver, and colleagues. It was published online in the Canadian Medical Association Journal.
LIMITATIONS:
The guideline was published more than 3 years after the initial literature search in September 2020 and did not include comprehensive guidance for AUD with co-occurring substance use disorders or with severe mental health conditions. Certain groups, including immigrant and refugee populations, were not represented.
DISCLOSURES:
Development of the guideline received support from Health Canada’s Substance Use and Addictions Program, Canadian Institutes of Health Research, and BC Centre on Substance Use. No committee members disclosed direct monetary or nonmonetary support from alcohol or pharmaceutical industry sources within the past 5 years, or that their clinical revenue would be influenced by the guideline recommendations.
A version of this article first appeared on Medscape.com.