Do you screen regularly for high-risk alcohol use? New national guideline says you should

Canada’s primary care physicians should screen patients regularly for alcohol use and ensure all adult and youth patients who appear to be high-risk drinkers undergo a diagnostic interview for alcohol use disorder and further assessment if needed These were among the 15 recommendations in a new national guideline for the clinical management of high-risk drinking and alcohol use disorder, which was published on October 16 in the Canadian Medical Association Journal. “Overall in Canada, we have a very high rate of drinking alcohol, way more than the average person drinks,” said study and guideline co-author Dr. Jürgen Rehm, a senior scientist in the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto. “In fact, Canadians are drinking over 50% more than the global average.” The new guideline—believed to be the first in Canada with a national scope—includes recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment. The latter includes psychosocial treatment interventions, pharmacotherapies and community-based programs. Read: ‘Much room for improvement’: meds for alcohol-use disorder are under-used, study says The guideline also lays out “principles of care” which the study authors said should be applied to all 15 recommendations “to establish positive partnerships” with patients and families dealing with alcohol use disorder. These principles include the importance of considering the social determinants of health, incorporating harm reduction and practices that take into account trauma and violence, and using culturally safe approaches as the standard of care. “The hope is that (the guideline) will help most Canadians in need get treatment, and that this treatment will actually be evidence-based,” said Dr. Rehm. “And also that it will help doctors avoid making the biggest mistakes when it comes to alcohol use disorder." One common mistake doctors make is avoiding any discussion of alcohol use with their patients. This often happens because some doctors are worried about how their will react if they ask about alcohol use. “The patient may have a fear of being stigmatized, of being seen as a bad character or not being strong enough to control his or her drinking,” said Dr. Rehn. “And the doctor may feel afraid of losing the patient or of having a poor relationship afterwards with the patient.” Read: Low-level drinking comes with risks Another mistake is the tendency among some physicians to prescribe the wrong medications, such as drug for depression or psychosis. “Unfortunately these kinds of medications not only do not help but, on average, are worsening the situation,” said Dr. Rehm. The guideline, which provided the basis for a new website called Helpwithdrinking.ca provides detailed recommendations at every stage and rates the strength and certainty of evidence for each recommendation . For example, it gives a “strong” rating to a withdrawal management recommendation to consider nonbenzodiazepine medications—such as gabapentin, carbamazepine or clonidine—for patients considered low risk for severe complications from alcohol withdrawal and who are in an outpatient setting such as a primary care clinic or telehealth. However it notes that the certainty of evidence for prescribing carbamazepine and clonidine is low, and moderate for gabapentin. “We try to start with very simple brief interventions, brief advice, but if necessary, we would go to the next level of doctors to specialists,” said Dr. Rehm. “We know people with alcohol use problems need better treatment and if we can achieve little steps in the right direction, then hopefully we can make a difference in the end.” Read: Why we need involuntary treatment for patients with severe SUDs

Do you screen regularly for high-risk alcohol use? New national guideline says you should

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