Alcohol Use Disorder in Adults: The Treatment Gap

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Alcohol use disorder (AUD) – formerly known as alcohol dependence or alcoholism –  is a matter of urgent concern in this country. Consider the statistics: an estimated 14.4 million Americans – slightly more men than women – have been diagnosed with some degree of the disorder. That’s nearly 13% of the population.

The social and economic costs of alcohol use disorder are considerable. Each year, an estimated 88,000 Americans die from alcohol-related causes. From job loss, to accidents and injuries, to healthcare costs from associated medical problems, alcohol misuse creates a significant burden on society. This makes the prevalence of alcohol use disorder something that matters to us all.

It’s not surprising, then, that research into new treatments is constant. Scientists continuously seek and test new treatments – and many of these are effective. People can and do get and stay sober. Treatment can save lives. Yet a recent study found that the rate of alcohol use disorder among adults in the United States has risen dramatically, not fallen, over the past two decades.

If effective treatments exist, why does the problem persist? A large part of the answer lies in what mental health professionals call the treatment gap.

What is the Treatment Gap?

Simply put, not everyone diagnosed with alcohol use disorder receives appropriate treatment or care. Statistics show that in the United States, of the vast numbers of people diagnosed, only about 8.0 % of men and 7.7 % of women sought treatment.

This problem has multiple underlying causes. Stigma is one of the most powerful and pervasive. In recent history, particularly in the U.S., the majority of people viewed AUD as a personal weakness or failure. The idea that the disordered use of alcohol is a moral failing, rather than a medical issue, originates in early cultural values of abstention, cleanliness, and discipline. Despite abundant research suggesting otherwise, the notion that a person can and should give up drinking by relying on willpower alone persists today.

Though social and cultural norms contribute to the roots of this attitude, it’s perpetuated not only in society at large, but sometimes within the medical profession, where people who seek treatment should expect to find evidence-based support and sound scientific information. Sadly, and somewhat paradoxically, there’s not only stigma surrounding people with AUD, but there’s also a stigma surrounding treatment for AUD.

Increase in Overall Consumption

Meanwhile, drinking alcohol became increasingly less stigmatized in recent years, even for demographics once strongly discouraged by social taboos from consuming alcohol at all, such as moms and older women.

These attitudes are nebulous, hard to pin down, and many people don’t realize they have and perpetuate them. But they have real and detrimental effects on people with drinking issues, and discourage them from seeking treatment. For those looking to change their habits around drinking, stigma and misinformation make it difficult to find reliable resources about the process of giving up alcohol. Some may be further disincentivized by fear of withdrawal symptoms, misconceptions about alcohol use disorder and sobriety, or simple lack of knowledge of the options available to them. Many will only seek treatment when forced by some extreme circumstance, such as a court order, accident or injury, or loss of employment, or a family intervention.

Gaps in Awareness, Gaps in Access

The stigma surrounding AUD and seeking treatment might be less problematic if everyone diagnosed with AUD had equal access to all available treatments. However, this is not the case. The availability of programs like mutual-help groups – a key part of the AA treatment model – varies by geographic location. In some poor or rural areas, there may be little to no access to treatment at all. And many insurance programs don’t cover treatment, making the cost problematic even in well-served areas.

There is also a lack of awareness of advances in treatment. For example, some medications have shown promise for reducing the severity of withdrawal symptoms. There are also medications that reduce the craving for alcohol. This can be a key advantage in creating behavioral change, since it helps break habitual patterns in the brain and gives new behaviors and skills learned in treatment time to take hold.

How Can We Address the Treatment Gap?

Though it won’t change overnight, increased attention to the model known as harm reduction is beginning to end the stigma surrounding the misuse of alcohol. This approach prioritizes the goal of minimizing the harmful outcomes of alcohol use, without demonizing or shaming the person seeking treatment and support.

Data also suggests that, when routine screening for problem alcohol use becomes part of a regular annual checkup, patients are able to see alcohol use disorder as a medical problem that can be addressed, just as high blood pressure must be treated and is addressed with medication and behavioral changes. Treatment options for alcohol use disorder, such as medication in combination with cognitive-behavioral therapy or mutual-help groups, can be discussed in a medical setting.

These approaches show promise in closing the treatment gap, and bringing relief and recovery to those who need it.