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Support people who abuse alcohol

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Communication and therapeutic skills can help pharmacists screen and educate patients on this sensitive topic.

As trusted healthcare professionals, community pharmacists have a responsibility to support patients who abuse alcohol.

According to the 2019 National Survey of Drug Use and Health, 14.5 million people in the United States suffer from alcohol use disorder (AUD) and alcohol-related causes are the third preventable cause of death in the United States behind smoking and poor diet. and physical inactivity.1 Pharmacists can screen and educate patients about various conditions, including AUD.

Reasoning

Many drugs interact with alcohol.2 These interactions have broad consequences, such as an increased risk of dizziness, drowsiness, and gastrointestinal bleeding. Heavy alcohol consumption worsens many chronic diseases, including cancer, cardiovascular disease, diabetes, digestive disorders and liver disease. Mental health disorders often coexist with AUD.2.3 Pharmacists can explore a patient’s alcohol consumption during a consultation for drugs that interact with alcohol and when dispensing drugs for comorbidities or conditions affected by alcohol abuse.4

The accessibility of community pharmacists goes beyond filling patients’ prescriptions. Patients may seek counseling for managing minor and limiting symptoms associated with alcohol.4 These include over-the-counter medications for emergency contraception, hangovers, headaches, indigestion, minor injuries, nausea, and vomiting. These conditions warrant investigation of alcohol use.4

Pharmacists should use a tool that is short, validated and easy to implement when screening for AUD. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a convenient screening tool (Table 1).5

The pharmacist’s next steps vary. They must have communication and therapeutic skills to navigate AUD conversations.4 Pharmacists should refer patients to a physician if they suspect potential AUD. The American Psychiatric Association recommends patient-centered treatment with non-pharmacological and pharmacological components.3

Appropriate therapy

Evidence-based non-pharmacological treatment for AUD includes motivation enhancement therapy (MET) and cognitive-behavioral therapy (CBT). MET is a technique derived from motivational interviewing, in which the patient’s beliefs and goals lead to change. The MET is generally a 90-day, 4-session framework.6 CBT integrates behaviors, feelings and thoughts, helping to manage triggers associated with alcohol consumption.7

Despite a high prevalence of AUD, less than 4% of people are prescribed one of 4 FDA-approved treatments for moderate to severe AUD1: oral acamprosate (Campral), oral disulfiram (Antabuse), intramuscular naltrexone (Vivitrol) and oral naltrexone (Révia). Gabapentin and topiramate are used off-label as treatments. Table 2 provides information on FDA-approved drugs.8,9,10,11 When identifying barriers to adherence or unsuccessful treatment, pharmacists should refer patients to their physician for potential treatment changes.

Limited literature examines pharmacist screening and brief interventions for substance use disorders, so more evidence is needed.4 Community pharmacists are expanding their role to provide advanced services, including chronic disease screening and management, smoking cessation, and treatment of minor ailments.12 Eventually, community pharmacies may offer brief AUD screening interventions. As with many services, reimbursement and staffing will be a challenge for the implementation of AUD interventions.

Conclusion

Whether it’s being the first contact with health care, screening patients with potential comorbidities, or counseling patients undergoing treatment, pharmacists can support people who misuse alcohol. Pharmacists must have the appropriate communicative and therapeutic skills to manage this sensitive topic.

Linsday Sawtelle is a PharmD candidate at the University of Connecticut School of Pharmacy at Storrs.

References

1. Facts and statistics about alcohol. National Institute on Alcohol Abuse and Alcoholism. Updated March 2022. Accessed March 1, 2022. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

2. Weathermon R, Crabb DW. Drug and alcohol interactions. Alcohol Res Health. 1999;23(1):40-54.

3. Reus VI, Fochtmann LJ, Bukstein O, et al. American Psychiatric Association practice guidelines for the pharmacological treatment of patients with alcohol use disorders. Am J Psychiatry.2018;175(1):86-90. doi:10.1176/appi.ajp.2017.1750101

4. Hattingh HL, Tait RJ. Pharmacy alcohol abuse services: current perspectives. Integr Pharm Res Practice. 2018;7:21-31. doi:10.2147/IPRP.S140431

5. Kriston L, Hölzel L, Weiser AK, Berner MM, Härter M. Meta-analysis: Are 3 questions enough to detect unhealthy alcohol consumption? Ann Medical Intern. 2008;149(12):879-888. doi:10.7326/0003-4819-149-12-200812160-00007

6. Lenz AS, Rosenbaum L, Sheperis D. Meta-analysis of randomized controlled trials of motivational enhancement therapy to reduce substance use. J Addict Offender Couns. 2016;37(2):66-86. doi:10.1002/jaoc.12017

7. Epstein EE, McCrady BS. A cognitive-behavioral treatment program for overcoming alcohol problems: A therapist’s guide. Oxford University Press; 2022.

8. Revia. Prescribing Information. Duramed Pharmaceuticals Inc.; 2013. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/018932s017lbl.pdf

9.Vivitrol. Prescribing Information. Alkermes, Inc.; 2021. https://www.vivitrol.com/content/pdfs/prescribe-information.pdf Comments limited to one page

10. Camprai. Prescribing Information. Forest Pharmaceuticals, Inc; 2005. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021431s013lbl.pdf

11. Antabuse. Prescribing Information. Duramed Pharmaceuticals Inc.; 2010.file:///C:/Users/cmollison/Downloads/20120420_12850de3-c97c-42c1-b8d3-55dc6fd05750.pdf

12. Mossialos E, Courtin E, Naci H, et al. From “retailers” to healthcare providers: transforming the role of community pharmacists in chronic disease management. Health policy. 2015;119(5):628-639. doi:10.1016/j.healthpol.2015.02.007