Monday, Feb. 5, 2018
Ninety percent of adults in the U.S. with an Alcohol Use Disorder don’t get treatment, according to the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health. To help make treatment more accessible, the NIH recently launched an online Alcohol Treatment Navigator, which gives providers and AUD patients information on evidence-based treatment options. The site also offers a brief survey to help a potential patient determine the range or severity of a problem.
Meeting patients where they are and then drawing them to the services that are most beneficial is the avenue by which more people will receive treatment and more AUD treatments will be developed, said Dace Svikis, Ph.D., a professor in the Department of Psychology in the College of Humanities and Sciences, the Department of Psychiatry and the VCU Health Department of Obstetrics and Gynecology. Svikis is currently working on several projects researching the effects of alcohol, modernized treatments and appropriately diagnosing AUD.
VCU and VCU Health are home to several programs to help varying demographics cope with AUD, including the multidisciplinary Alcohol Research Center, which focuses on preclinical and clinical studies to identify the root cause of alcohol misuse and alcoholism. Tools such as the NIAAA’s Alcohol Treatment Navigator modernize how patients are treated and revolutionize how treatment is offered and administered, Svikis said.
VCU News recently talked with Svikis to learn how VCU and VCU Health are helping patients by making sure treatment is accessible to anyone in need.
How has alcoholism traditionally been diagnosed?
- Traditionally, AUD, commonly referred to as alcoholism, is diagnosed when there is a problematic pattern of drinking that leads to clinically significant impairment or distress. To make a diagnosis, a trained clinician typically interviews the person about his or her drinking. The interviewer looks for evidence of several things:
- Impaired control or drinking more than intended
- Social impairment, such as conflicts with friends as a result of drinking or driving or operating machinery while inebriated
- Physical impairment
In what way has alcoholism traditionally been treated?
Historically, alcoholism treatment was associated with either long-term residential treatment or Alcoholics Anonymous. Since that time, the menu of treatment options for AUD has expanded considerably. AUD treatment modalities range from inpatient medical detoxification to short- or long-term residential treatment, to various outpatient treatment options. Evidence-based behavioral treatments for AUD include brief intervention, typically delivered in medical care settings like an emergency department, as well as cognitive behavioral therapy, motivational enhancement therapy, contingency management and behavioral couples and family counseling among others. While less well-known, there are also three Food and Drug Administration-approved nonaddictive medications for AUD: naltrexone, acamprosate and disulfiram.
In your professional opinion, how potentially useful is a tool like the Alcohol Treatment Navigator?
It is often challenging for individuals with AUD to obtain accurate information about alcohol treatment options and different paths to recovery. The Alcohol Treatment Navigator provides easy-to-understand information about AUD as a chronic, relapsing disorder and the range of well-researched alcohol treatment options to consider. This tool also makes it easier to search for local treatment options and other recovery resources, with a toolkit of downloadable worksheets to guide individuals in their search for appropriate, quality care. In addition, this tool provides information and support resources to people living with AUD and their family members.
How can addiction and treatment professionals use this type of tool to benefit patients?
Across a variety of settings, the Alcohol Treatment Navigator is something health care providers can make available to patients who report alcohol problems and are looking for the best local treatment options. It also can educate interested professionals about AUD and increase awareness about the range of evidence-based treatment options that exist in this country.
What recent studies has VCU been part of regarding the treatment of alcoholism?
VCU is involved in a variety of projects focused on the identification and treatment of heavy and problem drinking. One longstanding commitment is to community-based research through the National Institute on Drug Abuse Clinical Trials Network. In collaboration with Johns Hopkins University and Friends Research Institute, VCU represents the Mid-Atlantic branch of CTN.
Over the last 15 years, VCU researchers have contributed to several multi-site national studies of interventions such as motivational interviewing, medication-assisted treatment, and even an employment-focused intervention to improve outcomes in treatment. More recently, Lauretta Cathers, Ph.D., a faculty member in the Department of Rehabilitation Counseling in the School of Allied Health Professions, and I participated in a multi-site CTN study of the Tobacco, Alcohol, Prescription medication, and other Substance use measure — TAPS. The purpose of the study was to develop and test TAPS as a tool that could address the need for a brief screening and assessment instrument that would not only include all commonly used substances, but also could be implemented in routine clinical practice.
Is diagnosing alcoholism on a full spectrum a new concept or something you've recognized throughout your career?
Early in my career, I was taught that physical dependence on alcohol was an important factor in determining alcoholism severity. Particularly, it was important to assess the need for hospitalization, with medical management of the detoxification process. Subsequently, two diagnostic options were made available, with alcohol abuse generally considered less severe than alcohol dependence.
There is now a single diagnostic category, Alcohol Use Disorder, with several symptoms determining severity for any given individual. This single continuum and the labelling of severity by number of symptoms will likely make it a more salient variable in both clinical care and future research. At least two symptoms must be present to make a diagnosis, whereby more symptoms indicate greater severity. Symptom severity ranges from mild, two to three symptoms, to moderate, four to five symptoms. More than six symptoms indicates a severe problem.
What specific programs are in place at VCU (including referral programs) to treat and counsel people and families battling Alcohol Use Disorder?
Within VCU Health, hospitalized patients with AUD receive consultative services that include assessment, brief intervention and, when appropriate, referral to treatment. Many outpatient clinics at VCU routinely screen their patients to identify those at risk for problem drinking. Those identified, or who self-disclose an alcohol problem, also receive information about local treatment resources. Community Services Boards offer outpatient alcohol and other drug abuse treatment as well as mental health counseling and services. In the Richmond community, they include Richmond Behavioral Health Authority, Chesterfield Mental Health Support Services and Henrico Area Mental Health & Developmental Services.
VCU Health also has an outpatient facility, the MOTIVATE Clinic, established, in part, in response to the opioid epidemic. Many individuals who abuse opioids have comorbid conditions, including alcoholism, which is why this type of treatment is critical. For students, The Wellness Resource Center – The Well -- is available. The Well offers a variety of individual- and peer-focused educational programs on early intervention for alcohol and other substance use disorders. Particularly noteworthy is our RAMS in Recovery program, which is a nationally recognized, confidential, community-based resource for students in recovery from alcohol and other drugs. Also, through the College Behavioral and Emotional Health Institute and Spit for Science, we have a universitywide program focused on the study of alcohol, and other drug use, and emotional health outcomes in college populations.