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Sunspire Health Network

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An Old Disease with Modern Treatments (That Nobody Uses)
April 2nd, 2015 - Posted By Jonathan Horey, MD

Alcohol use disorder, more commonly called alcoholism, has been around likely as long as man has been making alcohol with historical estimates noting 10,000 B.C. as the earliest discovered containers of alcohol. Most cultures have had an ambivalent relationship with alcohol with some cultures worshipping wine gods but also warning against excessive consumption and others strictly forbidding it except for religious purposes (where it was often consumed in excess). Bill W and Dr. Bob brought alcoholism further into the public awareness in the early 1930s, by describing alcoholism as a disease, and AA has been instrumental in helping numerous people achieve lasting sobriety - even though the evidence base for the effectiveness of AA is lacking.

Since the 1930s there have been various other support groups and therapeutic modalities that have been utilized - with varied success- in combating this devastating disease. Only a few of these have been shown to be effective in trials, including Cognitive Behavioral Therapy and Motivational Interviewing. However, these evidence-based treatments are not commonly used in most substance abuse treatment centers.

Instead, older models of basic "milieu support" and an overreliance on self-help groups remain the norm. Beyond therapeutic modalities, the past few decades have seen an increase in the evidence-based pharmacologic treatments available to treat alcohol use disorders. These include newer medications like acamprosate and Vivitrol along with older, but effective, medications like Antabuse[1]. Here again, however, the treatment community has largely failed to modernize with a recent study showing that fewer than 10% of patients in treatment for alcohol use disorders are written prescriptions for one of these medications[2]. The reasons for this failure to use based treatments are many and include a small effect size, treatment community cultural bias against medications, institutional traditions at many treatment centers, larger sociocultural biases against the disease of addiction as well as a general lack of training in modern treatment modalities.

Regardless of the reasons, the fact remains that alcohol use disorders are severely undertreated with some estimates of less than 1/3 of those who meet criteria for alcohol use disorders receiving any treatment at all. For those that do manage to receive treatment, insult is added to injury by offering only non-evidence based therapeutic modalities.

At Sunspire Health, we are proud to offer and prioritize evidence based psychopharmacologic as well as psychotherapeutic treatment for alcohol use disorders, in addition to more holistic and self-help based modalities that can provide important adjunctive benefit for patients suffering from these disorders. Alcoholism has been around for millennia but the treatment of this most ancient of illnesses should incorporate the hope that new treatment provides rather than promote a reverence to treatments of the past.

[1] Maisel NC, et al Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? Addiction 2013 Feb; 108(2): 275-93.
[2] Jonas DE, et al Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and analysis. JAMA 2014; 311:1889-1900

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