Like many people who have trouble controlling their drinking, Andy Mathisen has tried many ways to limit.
He attended Alcoholics Anonymous meetings, went to a rehab center for alcohol abuse, and tried to use willpower to keep himself from binge drinking. But nothing seemed to work. Last year, when he was under the stress of the pandemic, he craved beer every morning, drank in his car and polished two liters of scotch a week.
Frustrated and feeling that his health and future are in a downward spiral, Mr Mathisen turned to the internet and discovered Ria Health, a telehealth program that uses online coaching and medication to help people curb their alcohol consumption without absolutely to refrain from alcohol.
After signing up for the service in March, he received coaching and a prescription for naltrexone, a drug that relieves cravings and decreases the high from alcohol. The program accepts some insurance and charges $ 350 per month for a one-year obligation for people paying out of pocket. Since he started, Mr. Mathisen has reduced his alcohol consumption significantly and limited himself to one or two drinks a few days a week.
“My alcohol consumption has gone down tremendously,” said Mr. Mathisen, 70, a retired telecommunications manager who lives in central New Jersey. “It no longer controls my life.”
Mr Mathisen is one of the roughly 17 million Americans grappling with alcoholism, the slang term for alcohol abuse, a problem that has worsened over the past year as the pandemic caused many anxious and isolated people to drink excessively. The National Institutes of Health define the disorder as “a disease characterized by an impaired ability to stop or control alcohol consumption despite negative social, occupational, or health consequences.” However, despite its prevalence, most people with the disorder go untreated even if they tell their family doctor or other healthcare professional about their drinking problem.
Last month, a nationwide study by researchers at Washington University School of Medicine in St. Louis found that about 80 percent of people who met criteria for alcohol use disorder went to a doctor, hospital, or medical clinic in the United States for a variety of reasons had previous year. About 70 percent of these people were asked about their alcohol consumption. Yet only one in ten have been encouraged by a doctor to reduce their alcohol consumption, and only 6 percent received any form of treatment.
Alcohol abuse can be caused by a complex number of factors including stress, depression, and anxiety, as well as a person’s genetics, family history, and socio-economic circumstances. Many people quit their heavy drinking habit on their own or through self-help programs like Alcoholics Anonymous or SMART Recovery. But the relapse rates are notoriously high. Research has shown that of all the alcohol abused people who try to quit drinking each year, only 25 percent are able to successfully reduce their alcohol consumption over the long term.
While there is no panacea for alcohol use disorders, several drugs have been approved for treatment, including pills like acamprosate and disulfiram, and oral and injectable forms of naltrexone. These drugs can dampen cravings and reduce the urge to drink, making it easier for people to stop or cut back when combined with behavioral interventions such as therapy.
However, despite their effectiveness, doctors rarely prescribe the drugs, even for people who are most likely to benefit, in part because many doctors are not trained in dealing with addiction or know about the drugs that are approved. In a study published last month, NIH scientists found that only 1.6 percent of the million Americans who abuse alcohol were prescribed a drug to help them control their alcohol consumption. “These are potentially life-saving drugs, and we have found that even in people with diagnosable alcohol disorder, the rate at which they are consumed is extremely low,” said Dr. Wilson Compton, study author and assistant director of the National Institute on Drug Abuse.
The effects of this are significant. Alcohol is one of the most common forms of substance abuse and a leading cause of preventable death and illness, killing nearly 100,000 Americans annually and contributing to millions of cancers, car accidents, heart attacks, and other illnesses. It is also a major cause of work accidents and lost productivity, as well as a driver of broken family and personal relationships. However, for various reasons, people who need treatment rarely get it from their doctors.
Some doctors believe that people struggling with alcohol are difficult patients with an intractable condition. Many patients who sign up for services like Ria Health do so after being turned away by doctors, said Dr. John Mendelson, Professor of Clinical Medicine at the University of California at San Francisco and Chief Medical Officer of Ria Health. “We have patients who come to us because their doctors have discharged them,” he added.
In other cases, doctors with no addiction background may fear that they may not have the expertise to treat alcoholism. Or they may feel uncomfortable prescribing medication for it, although it doesn’t require special training, said Dr. Carrie Mintz, assistant professor of psychiatry at Washington University and co-author of last month’s study, which looked at nationwide treatment rates.
The result is that many patients are referred to mental health experts or to rehab centers and 12-step programs like AA. sent
“The stigma of substance use disorders and treatment for them has historically been outside of the health system,” said Dr. Mintz. “We think these extra steps of referring people for treatment are an obstacle. We argue that treatment should be given directly at the point of care when people are in the hospital or clinic. “
But another reason for the low treatment rates is that problem drinkers often deny it, said Dr. Compton from the National Institute on Drug Abuse. Studies show that most people who meet the criteria for an alcohol use disorder do not feel they need treatment for it, even if they acknowledge that they have all of the hallmarks of the condition, such as a futile attempt to reduce alcohol consumption Having cravings and continuing to drink even though it is causing health and relationship problems.
“People are quite ready to tell you about their symptoms and the difficulties they are facing,” said Dr. Compton. “But when you say, ‘Do you think you need treatment?’ they will say they don’t. There is a blind spot when it comes to putting these pieces together. “
Studies suggest that a major barrier for people seeking treatment is believing that abstinence is their only option. This perception is fueled by the ubiquity and long history of 12-step programs like AA that preach abstinence as the only solution to alcoholism. This may be necessary for some people with severe drinking problems. However, studies show that people with lighter forms of alcohol consumption can improve their mental health and quality of life, as well as their blood pressure, liver health, and other aspects of their physical health, by reducing their alcohol consumption without completely giving up alcohol. But the idea that the only way to stop the cold turkey is to stop people from seeking treatment.
“People believe that abstinence is the only way – and, in fact, it’s not the only way,” said Katie Witkiewitz, director of the Addictive Behaviors and Quantitative Research Lab at the University of New Mexico and former president of the Society of Addiction Psychology. “We find great improvements in health and functioning when people reduce their alcohol consumption, even if they do not reduce to abstinence.”
For people who are concerned about their alcohol consumption, Dr. Witkiewitz to keep track of exactly how much you drink and then set goals based on how much you want to reduce your consumption. For example, if you typically consume 21 drinks a week, having only five to 10 drinks – on your own or with the help of a therapist or medication – said Dr. Witkiewitz. “Even this reduction will be linked to improvements in cardiovascular function, blood pressure, liver function, sleep quality, and mental health in general,” she added.
Here are some tools that can help.
Ria Health is a telemedicine program that treats people with alcohol abuse. It offers medical advice, online coaching, medication, and other tools to help people reduce their alcohol consumption or abstain if they prefer. It costs $ 350 a month for the annual program, is cheaper than most rehab programs, and accepts some forms of health insurance.
The National Institute on Alcohol Abuse and Alcoholism has a free website called Rethinking Drinking that can help you find doctors, therapists, support groups, and other ways to treat an alcohol problem.
Cutback Coach is a popular app that helps people track their alcohol consumption and set goals and reminders so they can develop healthier drinking habits. The service allows people to track their progress and sends daily reminders for motivation. The cost is $ 79 paid annually, $ 23 per quarter, or $ 9 per month.
Moderation management is an online forum for people who want to reduce their alcohol consumption, but do not necessarily want to do without it. The group offers meetings, both online and in person, where members can share stories, advice, and coping strategies. It also maintains an international directory of “moderation-friendly” therapists.
CheckUp & Choices is a web-based program that screens people for alcohol abuse. It gives feedback on your drinking habits and ways to reduce it. The service costs $ 79 for three months or $ 149 per year.