Interventions for Increasing Subsequent Alcohol Treatment Utilisation Among Patients With Alcohol Use Disorders From Somatic Inpatient Settings: A Systematic Review

N. Simioni; O. Cottencin; B. Rolland

Disclosures

Alcohol Alcohol. 2015;50(4):420-429. 

In This Article

Abstract and Introduction

Abstract

Aims: Alcohol Use Disorders (AUDs) are common in medical and surgical hospital wards. Brief Interventions (BIs) for reducing alcohol use and consequences are generally inefficacious in this population. Because there is evidence that receipt of formal treatment could be useful, we performed a systematic review to determine efficacious interventions for increasing subsequent alcohol treatment from these settings.

Methods: A systematic literature search of articles published prior to December 2013 to identify articles describing randomised controlled trials (RCTs) in three electronic databases: PubMed, PsycINFO and The Cochrane Library. Data were extracted independently by one reviewer and were checked by a second reviewer. Because of heterogeneity between study groups in treatment utilisation during the follow-up, a meta-analysis was considered inappropriate and a qualitative synthesis was conducted.

Results: From the 5030 identified records, only 5 RCTs, including 1113 patients with AUDs, met inclusion criteria. No evidence of efficacy in increasing subsequent treatment utilisation was reported for inpatient BIs alone, but interventions with post-discharge sessions might be beneficial. Increased treatment utilisation was generally associated with favourable drinking outcomes.

Conclusions: Given the small number of included studies and the presence of several alternative methodological explanations for the present findings, no firm conclusions could be drawn on efficacious interventions for increasing subsequent treatment utilisation among somatic inpatients with AUDs. However the findings support efforts to explore this under-researched area.

Introduction

Alcohol Use Disorders (AUDs) have been divided in two progressive stages: (a) alcohol abuse for the DSM-IV-TR (APA, 2000) or harmful alcohol use for the ICD-10 (WHO, 2007) and (b) alcohol dependence for both classifications. Approximately 5–10% of the adult population in Western countries are affected by AUDs (Rehm et al., 2009; WHO, 2014). AUDs often lead to serious long-term consequences including personal health problems, financial difficulties (Rehm et al., 2009) and mortality (Roerecke and Rehm, 2013). Although adequate extended treatment has been proven to be able to alleviate the long-term consequences of AUDs (McKay, 2005;2009; Lenaerts et al., 2014), less than 20% of people with AUDs will ever seek help and receive treatment for alcohol problems (Oleski et al., 2010). Consequently, increasing treatment rates has been identified as an important issue for future public health strategies on alcohol (Rehm et al., 2013) and it has thus been recommended to implement opportunistic screening using a validated questionnaire and to provide an intervention appropriate to alcohol use status in various settings, including healthcare settings such as primary healthcare, emergency departments and hospital wards (Haber et al., 2009; NICE, 2010).

Among these healthcare settings, medical and surgical wards (hereinafter referred to as 'somatic inpatient settings') seem to gather the ideal conditions to identify and engage patients with excessive drinking, including those with AUDs (O'Connor, 2007; McQueen et al., 2011). Indeed, the prevalence rate of AUDs in general hospital inpatients is at least twice higher than in the general population (Bischof et al., 2010) and alcohol-dependent individuals identified in general hospitals may have a greater motivation to change compared with those in the general population (Rumpf et al., 1999). Moreover, excessive alcohol users are accessible during an hospital stay and have more time for an intervention (Saitz et al., 2007) than in emergency departments (Weiland et al., 2008) or primary care settings (Wilson et al., 2011). In addition, excessive alcohol users may recognise the link between their hospitalisation and alcohol use (Saitz et al., 2007), and intervention benefits among medical inpatients who do not view their drinking as problematic may also be catalysed by having an alcohol-attributable illness at hospital admission (Williams et al., 2010).

In somatic inpatient settings, the focus has mainly been, in the last decade, on Brief Interventions (BIs) with a goal of reducing use and related consequences (Emmen et al., 2004; McQueen et al., 2011; Mdege et al., 2013), BIs being defined as session-limited interventions ranging from a short session of structured advice to several longer motivationally based sessions (NICE, 2010). Unfortunately, although BIs with a goal of reducing alcohol use and related consequences have been able to significantly foster drinking and related harms reduction without referring patients to addiction services in the less severe stages of excessive alcohol consumption [i.e. hazardous drinking, defined as exceeding the lower risk limits without experiencing consequences (NICE, 2010)], this type of interventions does not seem to be efficacious in patients with AUDs, and especially with severe AUDs (i.e. dependence) (Emmen et al., 2004; McQueen et al., 2011; Mdege et al., 2013). It is thus recommended that patients who show signs of severe AUDs should be referred for specialist treatment since receipt of alcohol treatment has been shown to be associated with favourable outcomes on drinking and related consequences not only in the general population (Dawson et al., 2012), but also in medical inpatients with excessive alcohol consumption after hospital discharge (Bertholet et al., 2010).

However evidence-based recommendations on how to refer those patients for specialist treatment from somatic inpatient settings are lacking. Since none of the previous systematic reviews on excessive drinkers in somatic inpatient settings (Emmen et al., 2004; McQueen et al., 2011; Mdege et al., 2013) have addressed this topic, we therefore performed a systematic literature review aiming to identify interventions efficacious for increasing subsequent alcohol treatment utilisation among patients with AUDs from somatic inpatient settings. Data on subsequent alcohol use and related consequences were also collected, when available, in order to evaluate the potential effect of such an approach on these outcomes in this population.

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