In the April 2015 SAMHSA-HRSA eSolutions newsletter, Dr. Charles O’Brien underlines the importance of putting evidence-based treatment strategies into practice by primary care physicians and behavioral health care providers. Dr. O’Brien, MD, PhD, is an internationally renowned expert on alcohol dependence and public policy. He is a Professor of Psychiatry at the University of Pennsylvania, where he also founded the Center for Studies in Addiction.
“We can keep doing clinical trials and other studies, but until providers adopt these approaches into their practice, the findings just sit there. Integrated care providers have the opportunity to show that people with alcohol use disorders can have better treatment outcomes and recovery rates than other chronic conditions,” O’Brien states.
In this brief interview, O’Brien discusses the importance of screening and early detection, and of treating co-occurring health problems simultaneously with alcohol addiction. He also advocates that treatment should focus on how to reduce and counter cravings for alcohol, not just make the patient feel at ease.
Medicines that effectively reduce cravings for alcohol have been approved by the FDA, but only ten percent of people in treatment receive medication. O’Brien cites lack of training in administering these medications to their low incidence of use. “We take medication to lower cholesterol, and it lowers risk for the condition. Why wouldn’t we do the same for treating alcohol use disorders?”
O’Brien offers advice for care providers on how to address alcohol use in integrated primary and behavioral health care settings:
- Always ask about a person’s drinking habits. Just as providers should always ask about depression and assess for suicide, clinicians must be comfortable talking about alcohol use. There are standard questions everyone can ask. Start with universal screening.
- Train staff in evidence-based practices. Review evidence-based practices on SAMHSA’s National Registry of Evidence Based Programs and Practices. Ensure staff train in these practices to stay up-to-date with the array of treatment options available. Make sure staff are aware of the connection between certain conditions and alcohol use.
- Be flexible and take advantage of all possible treatment options available. Strategies such as group therapy, family therapy and 12-step groups can be helpful, but providers should incorporate biological approaches (i.e., medications) as well. Providers should not be opposed to new approaches.
- Work with individuals with the long-term in mind. Teach people behaviors to adopt long-term to counter the cues that prompt cravings. Talk to individuals and family members about long-term treatment plans. Not where people should expect to be one month later, but year after year. Teach them skills to help them prevent relapse.
- Remember abstinence isn’t the only approach. Abstinence is the safest approach for someone with an alcohol use disorder, but reducing heavy drinking can also improve health. The FDA clarified that they will consider approving drugs for reduction of heavy drinking; not just those for abstinence. Even after detox, some people will have a strong tendency to keep going back. If someone chooses to continue to drink, we should not consider that a full-on relapse.