19 - Alcohol-use disorders: who should be treated and how?

Summary

Summary

Alcohol-use disorders are among the more prevalent mental disorders diagnosed in community surveys, yet only a small proportion of people with alcohol-use disorders seek or receive treatment from mental health or addiction treatment services. Although it is tempting to assume that these disorders are undertreated, treatment may not always be appropriate, since approximately half of the disorders detected in population surveys will remit without formal treatment. If not everyone with an alcohol-use disorder needs treatment, how should we deploy limited treatment resources to produce the greatest reduction in alcohol-related harm?

Public education about the risks of alcohol use may prevent and ameliorate the significant public health consequences of the prevalent, milder alcoholuse disorders. Education about self-help strategies for quitting or cutting down may obviate the need for professional assistance. Those whose problems resist self-help need more effective forms of treatment, more efficiently delivered than is often the case at present. Treatment services appear to routinely provide the most expensive, intensive and least effective forms of intervention to persons who present with alcohol-use disorders. Better triage would ensure a more rational use of scarce treatment resources.

Given the high rates of comorbidity between alcohol-use, anxiety, and affective disorders, the treatment of people with comorbid mental and alcohol-use disorders must be improved. Specialist mental health services need to recognize and treat comorbid alcohol-use disorders among their patients. Specialist alcohol treatment services need to give priority to better identification and management of anxiety and affective disorders among their patients since these are the mental disorders that are most prevalent and the most amenable to treatment.