Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go?
Open accessAbstract
AIMS: To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care. METHODS: Analyses of guidelines and recommendations, reviews and meta-analyses. RESULTS: Many recommendations or guidelines for interventions for people with alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: screening for alcohol use and alcohol-related problems, brief interventions for hazardous and in some cases harmful drinking, referral to specialized treatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders). CONCLUSIONS: A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.
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Conflicting priorities between a public health and prevention approach versus a clinical approach in which general practitioners may be more concerned with identifying and dealing with patients' existing problems is a reason for unsuccessful implementation of BIs.
“conflicting priorities between a public health and prevention approach versus a clinical approach in which general practitioners may be more concerned with identifying and dealing with patients’ existing problems [75]”
From Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions (2022) · cites this paper as [75]
Many of the less severe AUDs can be treated in the primary health-care system.
“and where many of the less severe AUDs can be treated [87].”
From Alcohol use and dementia: a systematic scoping review (2019) · cites this paper as [87]
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- Authors
- Rehm, J., Anderson, P., Manthey, J., Shield, K. D., Struzzo, P., Wojnar, M., & Gual, A.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Maastricht University (NL)
- Technische Universität Dresden (DE)
- University of Trieste (IT)
- Medical University of Warsaw (PL)
- Instituto de Salud Carlos III (ES)
- Corresponding author
- Rehm, Jürgen
- ORCID
- Venue
- Alcohol and Alcoholism
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-11-15
- Volume
- 51
- Issue
- 4
- Pages
- 422-427
- ISSN
- 0735-0414 (ISSN-L)
- 1464-3502
- OpenAlex
- W2269305868
- Semantic Scholar
- 2c27750fa1e3f1dd03ab587f14df131a121f1730
- Cited by
- 163
- References
- 80
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 14 · 2023: 9 · 2022: 11 · 2021: 26 · 2020: 17 · 2019: 25 · 2018: 17 · 2017: 10 · 2016: 12
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alcohol and Alcoholism (publishedVersion)
- PubMed (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- alcoholism, primary care, SBIRT, alcohol screening, brief intervention, guideline adherence, clinical practice, treatment initiation, behavioral interventions, pharmacotherapy, comorbidities, hypertension, insomnia, depression, anxiety disorders
- MeSH terms
- Humans, Primary Health Care, Practice Guidelines as Topic, Alcohol-Related Disorders
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