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Cited by 74Substance Abuse Treatment and OutcomesClinical practice guidelines implementationAlcohol Consumption and Health Effects

Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder

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Wood, Evan, Bright, Jessica, Hsu, Katrina, Goel, Nirupa, Ross, Josey W.G., Hanson, Averill, Teed, Rand, Poulin, Ginette +7 more·2023·Canadian Medical Association Journal
DOI 10.1503/cmaj.230715PMC PMC10581718
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Abstract

BACKGROUND: In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder. METHODS: Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders. RECOMMENDATIONS: The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes. INTERPRETATION: The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.

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  • The recent Canadian guideline on high-risk drinking and AUD management raises concerns regarding the use of SSRIs in individuals with AUD and non-substance-induced Major Depressive Disorder or anxiety disorders.

    “the recent Canadian guideline on high-risk drinking and AUD management, which raises concerns regarding the use of SSRIs in individuals with AUD and non-substance-induced Major Depressive Disorder (MDD) or anxiety disorders [59].”

    From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [59]

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Research works printed but not linked: 2

  1. [1]Pearson C Janz T Ali J. Mental and substance use disorders in Canada. Ottawa: Health at a Glance — Statistics Canada; 2015. Cat. no. 82-624-X. Available: https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11855-eng.htm (accessed 2023 May 10).
  2. [17]O’Connor EA Perdue LA Senger CA. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality; 2018. Available: https://www.uspreventiveservicestaskforce.org/home/getfilebytoken/h6SEK5cYmTKRECLtj3QxyA (accessed 2023 May 10). 30525341

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Authors
Wood, E., Bright, J., Hsu, K., Goel, N., Ross, J. W. G., Hanson, A., Teed, R., Poulin, G., Denning, B., Corace, K., Chase, C., Halpape, K., Lim, R., Kealey, T., & Rehm, J.
Affiliations
University of British Columbia (CA)
Corresponding author
Wood, Evan
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Impact Inc.
Published
2023-10-15
Volume
195
Issue
40
Pages
E1364-E1379
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.230715
PMC
PMC10581718
OpenAlex
W4387671486
Cited by
74
References
73
Citations by year
2026: 24 · 2025: 26 · 2024: 21 · 2023: 3
FWCI
14.71
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Canadian Medical Association Journal (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Health Canada
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
alcoholism, hazardous drinking, clinical management, alcohol screening, alcohol detoxification, psychosocial interventions, pharmacotherapy, community-based programs, evidence-based interventions, guideline recommendations, Canada
MeSH terms
Alcohol Drinking, Alcoholism, British Columbia, Humans

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