alcohol drinking

Evaluating and Treating Alcohol Use in Older Adult Patients

Nathan Hinkle — Tue, 04 Aug 2026 20:36:31 +0000

Date Added:

August 4, 2026

Journal/Publication:

Canadian Family Physician/Le Medecin De Famille Canadien

Publisher:

College of Family Physicians of Canada

Publication Date:

July 29, 2026

Issue:

7-8

Volume:

Pages:

466-468

URL:

Evaluating and treating alcohol use in older adult patients

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.46747/cfp.720708466

Keywords

alcohol use

older adults

cardiovascular disease

MeSH

alcohol drinking

frailty

aged

RPR Commentary: A review of the recognition, assessment, and treatment of older patients who regularly drink alcohol-containing beverages. James W. Mold, MD, MPH

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Clinical question
How do I evaluate and treat alcohol use in older
adult patients?
Bottom line
Although older adults generally drink less alcohol than
their younger counterparts,1 the consequences of use
are more severe. Older adults are more susceptible to
alcohol-related toxicity due to physiologic changes.2
The health impacts of heavy alcohol intake include
increased risks of cardiovascular disease, stroke, liver
disease, cancer, and mortality.3 Acute and chronic
alcohol use contributes to geriatric syndromes, such as
cognitive impairment, falls, frailty, and malnutrition.4

Author/s:

Frank, Chris, Molnar, Rummell, Sonja, Chan, Peter

Alcohol-Related Liver Disease A Review

Nathan Hinkle — Wed, 08 Jul 2026 17:54:03 +0000

Date Added:

July 8, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

July 6, 2026

Pages:

E1-E13

URL:

Alcohol-Related Liver Disease A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.7636

Keywords

Alcohol-related liver disease

ALD

alcohol use

MeSH

Liver Transplantation

Gastrointestinal Hemorrhage

alcohol drinking

RPR Commentary: A review of current knowledge about alcohol-related liver disease. James W. Mold, MD, MPH

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Abstract
Importance: Alcohol-related liver disease (ALD) is the leading cause of liver-related morbidity and mortality, and the most common indication for liver transplant in Europe and the US. In the US, ALD-related mortality increased from 6.7 deaths per 100 000 people in 1999 to 12.5 deaths per 100 000 people in 2022.

Observations: ALD can develop with long-term daily alcohol consumption of more than 20 g per day for women (1.4 standard drinks/d) and more than 30 g per day for men (2.1 standard drinks/d), with 1 standard drink containing 14 g of ethanol, equivalent to approximately 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits. ALD encompasses reversible steatosis; steatohepatitis, which can cause alcohol-associated hepatitis; and fibrosis, which can cause cirrhosis, portal hypertension, hepatic decompensation, and hepatocellular carcinoma. Risk factors for ALD progression include increased quantity and duration of alcohol use, female sex, older age, obesity, type 2 diabetes, metabolic syndrome, smoking, viral hepatitis, and specific genetic variants. Most patients with ALD (90%) are asymptomatic or have nonspecific symptoms, such as fatigue. Alcohol-associated hepatitis often causes fever, anorexia, nausea, vomiting, abdominal pain, and jaundice. Individuals with decompensated cirrhosis typically have ascites, variceal bleeding, jaundice, and/or hepatic encephalopathy. Noninvasive liver fibrosis tests, such as the Fibrosis-4 score (which includes alanine transaminase, aspartate aminotransferase, platelet count, and age), and more specific second-line tests, including liver stiffness measurement (vibration-controlled transient elastography) and blood-based fibrosis markers such as the enhanced liver fibrosis test and N-terminal propeptide of type III collagen, provide early diagnosis of ALD and assess liver fibrosis severity, which is the strongest predictor of liver-related outcomes. Alcohol cessation interventions such as motivational enhancement therapy, cognitive behavioral therapy, and pharmacologic therapy (eg, baclofen, naltrexone) are recommended to prevent disease progression. Because alcohol consumption is often underreported, screening tools, such as the Alcohol Use Disorders Identification Test, and sensitive biomarkers of recent alcohol intake (eg, blood phosphatidylethanol) may improve clinical accuracy. Sustained abstinence from alcohol is the primary treatment for ALD. Among patients with alcohol-related cirrhosis, alcohol abstinence over a median follow-up of 36 months was associated with reduced risk of liver-related mortality (adjusted hazard ratio, 0.43 [95% CI, 0.26-0.70]) and all-cause mortality (adjusted hazard ratio, 0.45 [95% CI, 0.30-0.67]). Liver transplant evaluation should be considered for patients with severe alcohol-associated hepatitis or decompensated cirrhosis.

Conclusions and Relevance: People with chronic daily heavy alcohol consumption should be assessed for ALD with noninvasive testing. The primary treatment goal is alcohol cessation. Patients with severe alcohol-associated hepatitis or decompensated cirrhosis should be considered for liver transplant.

Author/s:

Aleksander Krag, Frederik Aberg, Jessica Mellinger, Brian P. Lee, Mads Israelsen

What Is Atrial Fibrillation?

Erin Blanchette — Wed, 30 Apr 2025 21:32:57 +0000

Date Added:

April 30, 2025

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 24, 2025

URL:

What Is Atrial Fibrillation?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2025.2888

Keywords

atrial fibrillation

Cardiology

Patient Information

jama Patient Information

Rhythm Disorders

PMID (1):

40272794

MeSH

myocardial infarction

hypertension

stroke

sleep apnea syndromes

Information for patients about atrial fibrillation. James W. Mold, MD, MPH

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Atrial fibrillation is an abnormal heart rhythm that can cause stroke, heart failure, heart attack, chronic kidney disease, dementia, and death.

Atrial fibrillation is classified as paroxysmal (intermittent episodes lasting 7 days or less), persistent (lasting more than 7 days), long-standing persistent (lasting more than 1 year), or permanent.1

In the US, atrial fibrillation affects about 10.55 million people and is more common among men than women. Other risk factors include older age, smoking, high blood pressure, diabetes, heart disease, high alcohol consumption, sleep apnea, an overactive thyroid gland, and possibly genetic factors.

Author/s:

Rebecca Voelker

About Moderate Alcohol Use

Alex Haga — Thu, 30 May 2024 22:17:25 +0000

Date Added:

May 30, 2024

Journal/Publication:

CDC

Publication Date:

May 15, 2024

URL:

About Moderate Alcohol Use

Type:

Patient Education Materials

Format:

Article

Keywords

MeSH

Information for patients regarding moderate alcohol use and health. James W. Mold, MPH

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KEY POINTS
Drinking excessively increases your risk of getting sick, injured, or dying sooner.
You can choose not to drink alcohol, drink less, or drink in moderation to lower these risks, compared to drinking excessively.
However, even moderate drinking may increase your risk of death and other alcohol-related harms, compared to not drinking.

Reported Risky Alcohol Use Among US Adults Prescribed 3 Classes of Chronic Alcohol–Interactive Medications

Rowan Hutchins — Tue, 03 Oct 2023 05:00:00 +0000

Date Added:

October 3, 2023

Journal/Publication:

JAMA

Publisher:

AMA

Publication Date:

September 14, 2023

URL:

Reported Risky Alcohol Use Among US Adults Prescribed 3 Classes of Chronic Alcohol–Interactive Medications

Type:

Clinical Research Results

DOI (1):

10.1001/jama.2023.16641

Keywords

alcohol

drug interaction

PMID (1):

PMC10502693

MeSH

Drug Interactions

alcohol drinking

ethanol

More than 20% of patients taking opiates, seizure meds, and/or benzodiazepine receptor agonists report binge alcohol drinking while using those medications. Fewer than 3% of primary care visits include screening for alcohol misuse. James W. Mold, MD, MPH

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Alcohol-interactive medications pose increased risk of adverse events and death when used with alcohol.1 To our knowledge, the most recent study of alcohol use and alcohol-interactive medications included data through 2010.1 Mortality rates from alcohol and such medications have since increased.2,3 Therefore, we assessed contemporary patterns of risky alcohol use among adults taking high-risk alcohol-interactive medications.

Author/s:

Bernstein, Eden Y., Baggett, Travis P., Anderson, timothy S.

Alcohol Use Disorder and Alcohol-Associated Liver Disease

Aubrey Delammermore — Thu, 01 Dec 2022 06:00:00 +0000

Date Added:

December 1, 2022

Journal/Publication:

Alcohol Research Current Reviews

Publisher:

National Institute on Alcohol Abuse and Alcoholism

Publication Date:

November 10, 2022

Issue:

Volume:

Pages:

1-9

URL:

Alcohol Use Disorder and Alcohol-Associated Liver Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.35946/arcr.v42.1.13

Keywords

alcoholism

liver diseases

alcoholism complications

alcoholism diagnosis

alcohol misuse

PMID (1):

36420303

MeSH

alcohol drinking

Alcohol-Related Disorders*

National Institutes of Health (U.S.)

national institute on alcohol abuse and alcoholism (U.S.)

liver diseases, alcoholic*

A summary of current knowledge about alcohol use disorders and alcoholic liver disease. James W. Mold, MD, MPH.

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This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world’s largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, “Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research,” devoted to key topics within the field of alcohol research. This article is based on Dr. Shah’s presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

Author/s:

Ramissoon, R., Shah, V. H.

Looking Back, Looking Forward: Current Medications and Innovative Potential Medications to Treat Alcohol Use Disorder

Aubrey Delammermore — Sun, 06 Nov 2022 05:00:00 +0000

Date Added:

November 6, 2022

Journal/Publication:

Alcohol Research Current Reviews

Publisher:

National Institutes of Health

Publication Date:

October 20, 2022

Issue:

Volume:

URL:

Looking Back, Looking Forward: Current Medications and Innovative Potential Medications to Treat Alcohol Use Disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.35946/arcr.v42.1.11

Keywords

alcohol

alcoholism

National Institute on Alcohol Abuse and Alcoholism (U.S.)

National Institutes of Health (U.S.)

naltrexone

PMID (1):

36320345

MeSH

Alcohol Deterrents* / therapeutic use

Alcoholism* / diagnosis

Naltrexone / therapeutic use

alcohol drinking

Alcohol-Related Disorders*

A review of current and potential new medications for treatment of patients with alcohol use disorders. James W. Mold, MD, MPH

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This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Mason's presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

Author/s:

Mason, B. J.

Unhealthy alcohol use in a 65-year-old man awaiting surgery

Bethie Seay — Tue, 17 Aug 2021 05:00:00 +0000

Date Added:

August 17, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.202128

MeSH

substance withdrawal syndrome

Not surprisingly, unhealthy levels of alcohol use is associated with surgical complications. Adressing it through screening and clinical management could improve outcomes.

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Three months before elective hip arthroplasty, a 65-yearold man with osteoarthritis presents to his family physician to discuss his alcohol consumption. His surgeon had expressed concern and advised him to speak to his family physician about decreasing his drinking before surgery. He reports drinking around 6 to 10 ounces of whiskey daily for the past 5 years. His alcohol intake increased gradually after retirement, and he now has cravings daily. He recently abstained from alcohol for 4 days while visiting family and developed irritability, tremor, nausea and headache. He has never had withdrawal seizures or delirium tremens, and he does not use any other substances. He is otherwise healthy, apart from hypertension that is controlled with perindopril. He is alarmed by his cravings, withdrawal symptoms and surgeon’s concerns, and is considering decreasing his alcohol use.

Author/s:

Brothers, T. D., Kaulbach, J., Tran, A.

Perioperative alcohol cessation intervention for postoperative complications

Brian Desmarais — Sat, 15 Aug 2020 19:59:34 +0000

Date Added:

August 15, 2020

Journal/Publication:

The Cochrane Database of Systematic Reviews

Publication Date:

November 8, 2018

Issue:

Volume:

URL:

Perioperative alcohol cessation intervention for postoperative complications

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD008343.pub3.

MeSH

Postoperative Complications

This Cochrane review suggests that efforts to help adults with a history of risky alcohol consumption to quit prior to and following surgery reduces surgical complications including mortality. That isn’t surprising, but we haven’t always paid as much attention to alcohol consumption as we have to smoking as a risk factor for surgical complications. James W. Mold, MD, MPH

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Background: Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery.This review was first published in 2012 and was updated in 2018.

Objectives: To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption.

Search methods: We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information.

Selection criteria: We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention.We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies.

Data collection and analysis: We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach.

Main results: We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.

Authors' conclusions: This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.

Conflict of interest statement

Hanne Tønnesen has authored all three of the studies included in this review (Egholm 2017; Tønnesen 1999a; Tønnesen 2002).

Julie Weber Melchior Egholm, Johanna Adami, and Bolette Pedersen have authored one of the included studies (Egholm 2017).

Hanne Tønnesen is also the primary investigator for the ongoing study (NCT02188446).

Therefore, to avoid any potential bias, Carsten B Juhl extracted data and checked the interpretation against study reports and any available study registration details or protocols as an independent review author.

Author/s:

Egholm, Julie W., Pedersen, Bolette, Møller, Ann M., Adami, Johanna, Juhl, Carsten B., Tønnesen, Hanne

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Brian Desmarais — Fri, 05 Jun 2020 18:28:32 +0000

Date Added:

June 5, 2020

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

May 21, 2020

Volume:

225

URL:

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.23970/AHRQEPCCER225

Keywords

MeSH

Family Characteristics

An AHRQ systematic review of substance abuse disorders in adolescents. James W. Mold, MD, MPH

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Structured Abstract

Objectives. This systematic review (SR) synthesizes the literature on behavioral, pharmacologic, and combined interventions for adolescents ages 12 to 20 years with problematic substance use or substance use disorder. We included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms.

Data sources. We conducted literature searches in MEDLINE, the Cochrane CENTRAL Trials Registry, Embase, CINAHL, and PsycINFO to identify primary studies meeting eligibility criteria through November 1, 2019.

Review methods. Studies were extracted into the Systematic Review Data Repository. We categorized interventions into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. We conducted meta-analyses of comparative studies and evaluated the strength of evidence (SoE). The PROSPERO protocol registration number is CRD42018115388 .

Results. The literature search yielded 33,272 citations, of which 118 studies were included. Motivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month, and overall substance use problems by a standardized mean difference of 0.5, compared with treatment as usual. Brief MI did not reduce cannabis use days (net mean difference of 0). Across multiple intensive interventions, Fam was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual. No intensive interventions reduced cannabis use days. Pharmacologic treatment of opioid use disorder led to a more than 4 times greater likelihood of abstinence with extended courses (2 to 3 months) of buprenorphine compared to short courses (14 to 28 days).

Conclusions. Brief interventions: MI reduces heavy alcohol use (low SoE), alcohol use days (moderate SoE), and substance use–related problems (low SoE) but does not reduce cannabis use days (moderate SoE). Nonbrief interventions: Fam may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Intensive interventions did not appear to decrease cannabis use (low SoE). Some interventions (CBT, CBT+MI, and CBT+MI+CM) were associated with increased cannabis use (low SoE). Both MI and CBT reduce combined alcohol and other drug use (low SoE). Combined CBT+MI reduces illicit drug use (low SoE). Subgroup analyses of interest (male vs. female, racial and ethnic minorities, socioeconomic status, and family characteristics) were sparse, precluding conclusions regarding differential effects. Pharmacological interventions: longer courses of buprenorphine (2–3 months) are more effective than shorter courses (14–28 days) to reduce opioid use and achieve abstinence (low SoE). SRs in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for opioid, alcohol, and cannabis use disorders.

Citation

Suggested citation: Steele DW, Becker SJ, Danko KJ, Balk EM, Saldanha IJ, Adam GP, Bagley SM, Friedman C, Spirito A, Scott K, Ntzani EE, Saeed I, Smith B, Popp J, Trikalinos TA. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCER225 .

Author/s:

Steele, D.W., Becker, S.J., Danko, K.J., Balk, E.M., Saldanha, I.J., Adam, G.P., Bagley, S.M., Friedman, C., Spirito, A., Scott, K., Ntzani, E.E., Saeed, I., Smith, B., Popp J., Trikalinos, T.A.

Evidenced-Based Pharmacotherapies for Alcohol Use Disorder

John Bayhi — Thu, 21 May 2020 16:22:32 +0000

Date Added:

May 21, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc / Mayo Foundation for Medical Education and Research

Publication Date:

May 20, 2020

Volume:

Article in Press

URL:

Evidenced-Based Pharmacotherapies for Alcohol Use Disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.01.030

Keywords

MeSH

Pharmacogenomic Testing

united states food and drug administration

A review of pharmacological approaches to the treatment of alcoholism with some clinical pearls from Mayo physicians. James W. Mold, MD, MPH

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Pathologic alcohol use affects more than 2 billion people and accounts for nearly 6% of all deaths worldwide. There are three medications approved for the treatment of alcohol use disorder by the US Food and Drug Administration (FDA): disulfiram, naltrexone (oral and long-acting injectable), and acamprosate. Of growing interest is the use of anticonvulsants for the treatment of alcohol use disorder, although currently none are FDA approved for this indication. Baclofen, a γ-aminobutyric acid B receptor agonist used for spasticity and pain, received temporary approval for alcohol use disorder in France. Despite effective pharmacotherapies, less than 9% of patients who undergo any form of alcohol use disorder treatment receive pharmacotherapies. Current evidence does not support the use of pharmacogenetic testing for treatment individualization. The objective of this review is to provide knowledge on practice parameters for evidenced-based pharmacologic treatment approaches in patients with alcohol use disorder.

Author/s:

Fairbanks, J, Umbreit, A, Kolla, BP, Karpyak, VM, Schneekloth, TD, Loukianova, LL, Sinha, S

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

John Bayhi — Sat, 14 Mar 2020 20:31:53 +0000

Date Added:

March 14, 2020

Journal/Publication:

MMWR Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

March 13, 2020

Issue:

Volume:

Pages:

265-270

URL:

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm6910a3

Keywords

alcohol use

screening and brief intervention

alcohol SBI

binge drinking

PMID (1):

32163383

MeSH

Behavioral Risk Factor Surveillance System

Fetal Alcohol Spectrum Disorders

Public Health Practice

health personnel

Evidence-Based Medicine

insurance coverage

Telephone

Centers for Disease Control and Prevention

U.S.

Longitudinal Studies

The CDC recommends screening all adults for binge drinking with a single question and recommending reduction to those who screen positive. James W. Mold, MD, MPH

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What is already known about this topic?

Binge drinking increases the risk for adverse health conditions and death. Alcohol screening and brief intervention (SBI), recommended by the U.S. Preventive Services Task Force (USPSTF) for all adults in primary care, is effective in reducing binge drinking.

What is added by this report?

In 2017, 81% of survey respondents were asked by their health care provider about alcohol consumption and 38% about binge drinking at a checkup in the past 2 years. Among those asked about alcohol use and who reported current binge drinking, 80% received no advice to reduce their drinking.

What are the implications for public health practice?

Implementation of alcohol SBI as recommended by USPSTF, coupled with population-level evidence-based interventions, can reduce binge drinking among U.S. adults.

Author/s:

McKnight-Eily, LR, Okoro, CA, Turay, K, Acero, C, Hungerford, D

Alcohol Abstinence in Drinkers with Atrial Fibrillation

Brian Desmarais — Fri, 03 Jan 2020 22:27:35 +0000

Date Added:

January 3, 2020

Journal/Publication:

New England Journal of Medicine

Publication Date:

January 2, 2020

Issue:

Volume:

382

Pages:

20-28

URL:

Alcohol Abstinence in Drinkers with Atrial Fibrillation

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1093/ntr/ntz234

Keywords

MeSH

Not surprisingly, reducing alcohol intake reduces the frequency of atrial fibrillation in patients known to have had episodes of atrial fibrillation.

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BACKGROUND:

Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.

METHODS:

We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.

RESULTS:

Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).

CONCLUSIONS:

Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).

Author/s:

Voskoboinik, A., Kalman, J.M., De Silva, A., Nicholls, T., Costello, B., Nanayakkara, S., Prabhu, S., Stub, D., Azzopardi, S., Vizi, D., Wong, G., Nalliah, C., Sugumar, H., Wong, M., Kotschet, E., Kaye D., Taylor, A.J., Kistler, P.M.

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Jeffrey Wilson — Wed, 02 Jan 2019 14:31:45 +0000

Date Added:

January 2, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 1, 1997

Issue:

Volume:

277

Pages:

1039-1045

URL:

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.1997.03540370029032

Keywords

PMID (1):

9091691

MeSH

In this RCT conducted in primary care settings, two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information was sufficient to reduce 7-day alcohol use from 19.1 to 11.5 at 12 months in the experimental group vs 18.9 at baseline to 15.5 at 12 months in controls (P<.001); episodes of binge drinking from 5.7 at baseline to 3.1 at 12 months in the experimental group vs 5.3 at baseline to 4.2 at 12 months in controls (P<.001), and percentage drinking excessively in previous 7 days from 47.5% at baseline to 17.8% at 12 months in the experimental group vs 48.1% at baseline to 32.5% at 12 months in controls (P<.001) at one year.

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OBJECTIVE:

Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers.

DESIGN:

Randomized controlled clinical trial with 12-month follow-up.

SETTING:

A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties.

PARTICIPANTS:

Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures.

INTERVENTION:

The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information.

MAIN OUTCOME MEASURES:

Alcohol use measures, emergency department visits, and hospital days.

RESULTS:

There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01).

CONCLUSIONS:

This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.

Author/s:

Fleming, Michael F., Barry, Kristen L., Manwell, Linda B., Johnson, Kristen, London, Richard

Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up

Jeffrey Wilson — Wed, 02 Jan 2019 14:26:10 +0000

Date Added:

January 2, 2019

Journal/Publication:

Journal of General Internal Medicine

Publisher:

Society of General Internal Medicine

Publication Date:

January 1, 2005

Issue:

Volume:

Pages:

7-13

URL:

Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/j.1525-1497.2005.21240.x

Keywords

alcohol

alcoholism

PMID (1):

15693921

MeSH

In this RCT conducted in academic primary care practices, brief (5–10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials was sufficient to reduce weekly alcohol intake in patients with unhealthy alcohol intake one year post-intervention.

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BACKGROUND:

The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice.

METHODS:

We performed a controlled clinical trial with 6- and 12-month follow-up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high-risk drinking. A fourth site was added later. From the group that was screened, 530 high-risk drinkers entered into the study, with 447 providing follow-up at 12 months. The intervention consisted of brief (5-10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials.

RESULTS:

At 12-month follow-up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=-5.7 drinks per week; UC=-3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC.

CONCLUSIONS:

Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.

Author/s:

Reiff-Hekking, Sarah, Ockene, Judith K., Hurley, Thomas G.