Stigma, lack of awareness linked to underutilization of medications that treat alcohol use disorder: B.C. study

A new study is highlighting a huge gap in the treatment of alcohol use disorder (AUD) in British Columbia, which researchers believe is largely due to a lack of awareness and stigma.

Findings published Tuesday by the BC Centre on Substance Use suggest fewer than five per cent of people with the disorder are accessing evidence-based treatment.

For the study, researchers took a random, 20 per cent sample of British Columbians between 2015 and 2019 in order to determine who met the criteria for moderate-to-severe AUD and whether those individuals received medications to treat the disease.

AUD is defined as a “a chronic and relapsing condition,” with clinical guidelines recommending at least three to six months of pharmaceutical intervention as a first-line treatment—including medications like naltrexone, acamprosate and disulfiram.

All three medications are approved by Health Canada and considered the “gold standard” for AUD treatment, the study explains.

While naltrexone and acamprosate block neural pathways linked to the rewarding effects, cravings and motivations around alcohol consumption, disulfiram triggers unpleasant physiological reactions when booze is consumed.

While the study found that access to medications had increased by 2019, the number of people who started and retained treatment remained low.

Similar to the national average, and estimated 18.2 per cent of British Columbians meet the criteria for AUD and heavy drinking in 2019.

That same year, the rate of hospitalizations entirely caused by alcohol was similar to those for heart attack and up to four times higher than those caused by opioids or cannabis, according to the study.

Dr. Eugenia Socías, the study’s lead author, is hoping the research will raise awareness when it comes to addiction treatment and help reduce stigma around the disease.

“There is a lot of media attention put to the opiate crisis—which is not to say that’s wrong, but alcohol use disorder has a higher burden of disease,” Socías told CTV News on Wednesday.

According to the study, alcohol was involved in more than a quarter of illicit drug deaths recorded in 2019.

“Unfortunately, there’s still widespread stigma around alcohol use disorder or any substance use disorder being (perceived as) a behavioural choice, rather than a disease,” Socías said. She believe a lack of addiction training among medical providers could also explain the lack of treatment access and retention.

However, a lot has happened since the study was conducted---including the pandemic.

“What we do know is that during COVID and after COVID, the harms related to alcohol increased, so I would think there is probably a larger burden of alcohol use disorder,” said Socías.

In the medical research world, a formula called The Number Needed to Treat (NNT) demonstrates the effectiveness of pharmaceutical interventions when it comes to supporting people with AUD.

The measurement is used to determine how many patients require treatment in order to achieve a positive outcome for one individual.

“ For naltrexone and acamprosate, this number ranges between nine and 10—depending on if we’re looking at abstinence of reducing heavy drinking,” said Socías.

By comparison, when it comes to using aspirin for the secondary prevention of cardiovascular disease, Socías says the NNT is 50. For antihypertensive medication that prevent strokes, the NNT is 67.

“We know that no clinicians will doubt for a second when prescribing either aspirin or imperative medications—actually, not prescribing them would be considered a major deviation from the standard of care,” Socías said.

“There is a lot that we need to do to bring the clinicians mind to similarly using these safe and very effective medications for alcohol use disorder. It should be part of their toolkit to offer to patients when they seek help.”