Detecting Alcohol Use Disorder: The Crucial Role of Primary Care Providers
Welcome to our latest newsletter! In this edition, we delve into the vital role primary care providers (PCPs) play in detecting and managing alcohol use disorder (AUD). As the first point of contact for many patients within the healthcare system, PCPs are uniquely positioned to identify early signs of problematic drinking and intervene before the condition escalates. Through routine screenings, patient education, and ongoing support, PCPs are essential in the fight against AUD.
This week, we have Casey Grover, MD FACEP FASAM , discussing how to include addiction medicine as a part of everyone's practice. Dr. Grover is board-certified in Addiction Medicine and Emergency Medicine. He currently practices Addiction Medicine in Monterey, CA. He also hosts a podcast called "Addiction Medicine Made Easy," where he breaks down topics in addiction medicine into digestible nuggets and clinical pearls for bedside use.
What is the role of a PCP in detecting unhealthy alcohol use? What steps can they take for early detection and prevention of AUD?
Alcohol use disorder is a disease that has a huge impact on the United States, resulting in the deaths of over 100,000 Americans per year. Primary care physicians often screen for unhealthy habits such as excessive alcohol use during routine appointments and physicals. I would love to see more primary care physicians take the next step once unhealthy alcohol use is detected and offer some basic treatment for alcohol use disorder, such as prescribing medications like naltrexone to reduce alcohol use and connecting patients with counseling and mutual support groups. We are working on an education campaign for PCPs in my area on how to use medications to treat alcohol use disorder.
You talk about how addiction is a "team sport." What do you mean by this, and how can providers integrate patients' loved ones into the treatment process?
Addiction is one of the most devastating illnesses we treat in medicine, often affecting the whole family. My patients with addiction do best when they have a lot of support from both their family and their healthcare team. I encourage family members to play an active role in their loved one's treatment for addiction. There are also more levels of complexity to this. Who a person associates with and lives with will affect their treatment for addiction. For example, if a married couple who lives together both drink alcohol, and one wants to quit but the other does not, it can be very hard to quit alcohol as there will still be alcohol in and around the home. Conversely, if a person has an addiction to alcohol and the rest of their family doesn't drink, that person's home environment is going to be very supportive of an alcohol-free life.
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What brought you to do work in this space?
I practiced Emergency Medicine for nearly 15 years and found addiction to be one of the most frustrating conditions to treat. Addiction is so damaging to a person's life and health, there was so much recidivism, and I had not received any training in medical school or residency on how to treat addiction. A colleague and I started an initiative to try to reduce the amount of opioids being prescribed in our community, and as we learned more about opioids through our work on this initiative, we learned more about addiction. We realized that we could make a huge difference in our community by learning how to treat addiction. So, we started educating ourselves about addiction and eventually began treating patients with opioid use disorder with buprenorphine. As time went by and we saw the positive effect we were having in our patients' lives, we decided to pursue Addiction Medicine full-time.
Where do you want to see new solutions emerging in alcohol prevention and/or addiction care?
We need more medications to reduce cravings for substances. For opioid use disorder, we have great medications: methadone and buprenorphine. They are incredibly effective at reducing cravings for opioids and treating opioid dependence and withdrawal. For alcohol use disorder, our medications are only moderately effective at best: naltrexone, acamprosate, and disulfiram. We need continued research into medications that are more effective for the treatment of alcohol use disorder. However, for cannabis, benzodiazepines, and stimulants, we are really in a bad place: we have no FDA-approved medications to treat these addictions.
Thank you so much Casey Grover, MD FACEP FASAM for sharing insights!
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