BY Samuel Mathis MD, MBA, UTMB
Recently, the World Health Organization (WHO) published a statement that there is no safe amount of alcohol that does not affect our health. This is a shift from prior recommendations that found some potential cardiac benefit from moderate intake of certain alcohol-containing beverages. With this new guidance, it is more important than ever that we engage with our patients about alcohol use and the potential harm. For those interested in stopping, there are some integrative therapies that can also help decrease alcohol use or diminish the harmful effects of its use.
In the United States, alcohol use screening is significantly lower than what it should be. A 2015 study found that while the USPSTF recommends screening of all adults, only 25% of individuals were screened for alcohol use during a routine office visit (1). This low percentage of screening is concerning as it is estimated that approximately 54% of US adults have used alcohol monthly. Additionally, it may often take numerous inquiries before a patient divulges their alcohol use to their physician. Alcohol consumption is related to many negative health outcomes both physically, psychologically, and socially. It has been shown that alcohol use increases the risk of hypertension, cardiovascular disease, cancer, liver disease, neurological and psychological conditions, infections, and the development of endocrine disruption (2). Long term use of alcohol may impact neurological function, and significant abuse can cause Werneke’s encephalopathy. Older adults who drink alcohol are more likely to suffer falls or physical harm associated with intoxication. With so many potential complications, it’s no wonder that the WHO has now deemed there to be no safe amount of alcohol consumption.
The question then becomes how we help our patients cut back on their alcohol consumption. The first step should be screening. While screening has been primarily a primary care physician concern, with the numerous complications associated with alcohol use, screening should be considered in both primary and specialty care settings. This includes surgical settings as well due to the risk of withdrawal and poor wound healing with chronic alcohol use. One of the easiest ways to screen is using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) or the Single Alcohol Screening Question (SASQ) as quick tools to assess patients’ alcohol use. If positive, these screening tools should lead to a more detailed discussion regarding the amount and how to cut back or stop alcohol consumption (2). For patients with significant concerns for substance abuse disorder, referral for further evaluation and treatment may be necessary. However, there are some integrative therapies that may be helpful for some patients as they work to cut back on their alcohol use.
There have been a few studies looking at integrative therapies for alcohol use; however, these studies have been small or have not had significant findings. Nevertheless, there are some options that may be helpful. A 2009 review of integrative therapies for substance use disorders found that behavioral counseling, some herbal therapies, and acupuncture had the greatest amount of evidence for positive impact in treating substance use disorders (3). Behavioral counseling is a longstanding treatment option for individuals who struggle with excessive alcohol intake. We see this benefit in the numerous success stories with individuals using alcoholics anonymous and other behavioral group therapies. Acupuncture has some promising studies looking at reducing the dopamine release associated with alcohol consumption, but many of these studies were animal studies and the results, while positive, have not been as strong as many would hope. Some homeopathy treatments and herbal treatments such as kudzu and St Johns Wort have some positive effects in reducing alcohol intake in animal studies. However, caution should be used with St. Johns Wort given the possibility of drug interactions (3).
Alcohol use is prevalent in a majority of US adults. As physicians we should be working to educate and screen our patients for alcohol use disorders and provide them the resources needed to help them reduce their intake for their overall health. While there may be some benefit with certain integrative therapies, our more conventional medical therapies seem to have better evidence of their effectiveness at this time.
References:
- Denny CH, Hungerford DW, McKnight-Eily LR, Green PP, Dang EP, Cannon MJ, Cheal NE, Sniezek JE. Self-Reported Prevalence of Alcohol Screening Among U.S. Adults. Am J Prev Med. 2016 Mar;50(3):380-383. doi: 10.1016/j.amepre.2015.09.016. Epub 2015 Oct 29. PMID: 26520573; PMCID: PMC4762725.
- Donroe JH, Edelman EJ. Alcohol Use. Ann Intern Med. 2022 Oct;175(10):ITC145-ITC160. doi: 10.7326/AITC202210180. Epub 2022 Oct 11. PMID: 36215713.
- Behere RV, Muralidharan K, Benegal V. Complementary and alternative medicine in the treatment of substance use disorders–a review of the evidence. Drug Alcohol Rev. 2009 May;28(3):292-300. doi: 10.1111/j.1465-3362.2009.00028.x. PMID: 21462415.