The first-ever Canadian guideline for treating high-risk drinking and alcohol use disorder (AUD) has been published by the BC Centre on Substance Use (BCCSU), a UBC Faculty of Medicine research centre housed within Providence Health Care and Providence Research.
Developed in partnership with the Canadian Research Initiative on Substance Misuse (CRISM), the guideline provides 15 evidence-based recommendations to reduce harms associated with high-risk drinking and to support people’s treatment and recovery from AUD.
Along with the new clinical guidelines, a website has been developed, called helpwithdrinking.ca, to raise awareness of resources and treatments available to Canadians. These resources do not make recommendations for reducing health risks associated with alcohol, but provide Canadians with information about what treatments are available for high-risk drinking and how they can be accessed.
Over half of Canadians over 15 drink more than recommended amount
High-risk drinking, AUD and alcohol-related harms are common in Canada. Nearly 18 per cent of people aged 15 years or older in Canada will meet the clinical criteria for an AUD in their lifetime, and over 50 per cent of people in Canada aged 15 years or older currently drink more than the amount recommended in Canada’s Guidance on Alcohol and Health.
Despite the high prevalence of high-risk drinking and AUD, these conditions frequently go unrecognized and untreated in the health care system. Even if recognized, AUD does not receive evidence-based interventions. It’s estimated that less than two per cent of eligible patients receive evidence-based alcohol treatment in the form of evidence-based pharmacotherapies, likely owing to low awareness. Conversely, according to the guideline, many Canadian patients receive medications that may be ineffective and potentially harmful.
To address this health issue, Health Canada funded CRISM and the BCCSU to develop the “Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder.” The guideline provides recommendations for the clinical management of high-risk drinking and AUD to support primary health care providers to implement evidence-based screening and treatment interventions.
The guidelines were written by a 36-member committee co-chaired by Dr. Evan Wood, a professor in UBC’s department of medicine and Canada Research Chair in addiction medicine, and Dr. Jürgen Rehm, senior scientist at the Centre for Addiction and Mental Health (CAMH) and a professor in the Dalla Lana School of Public Health at the University of Toronto.
The guideline is based on the latest evidence, expert consensus, and lived and living experience, as well as clinical experience from across Canada. It makes 15 recommendations for care providers about how to ask about alcohol, diagnose AUD, manage alcohol withdrawal, and create treatment plans based on the individual’s goals. These treatment plans can include medications, counselling, harm reduction or a combination.
Complexities of providing treatment
A related practice article highlights the complexity of providing treatment to patients with AUD and the possible negative effects of selective serotonin reuptake inhibitor (SSRI) therapy, which can worsen the disease in some people.
The guideline recommends against SSRI antidepressants in patients with AUD, or AUD and concurrent anxiety or depression.
“Despite the burden of illness, there remains a tremendous gap between what we know is effective treatment and the care Canadians are actually receiving,” says Dr. Evan Wood, co-chair of the guideline writing committee and an addiction medicine specialist at UBC. “Unfortunately, in the absence of effective care, people are being routinely prescribed potentially harmful medications that can, unknown to most prescribers, actually increase alcohol use in some patients. These guidelines seek to close that gap and ensure Canadians are accessing the safest and most effective treatments that meet their needs.”
This story is based on a news release issued by the Canadian Medical Association Journal