Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-17T09:16:43.783Z Has data issue: false hasContentIssue false
  • English
  • Français

Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care

Published online by Cambridge University Press:  05 October 2015

J. Rehm ,
J. Manthey ,
P. Struzzo ,
A. Gual  and
M. Wojnar
J. Rehm
Affiliation:
Centre for Addiction and Mental Health, 33, Russell Street, Toronto, ONM5S 2S1, Canada Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155, College Street, 6th floor, Toronto, ONM5T 3M7, Canada Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1, King's College Circle, Room 2374, Toronto, ONM5S 1A8, Canada Department of Psychiatry, University of Toronto, 250, College Street, 8th floor, Toronto, ONM5T 1R8, Canada Institute of Clinical Psychology and Psychotherapy & Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187Dresden, Germany
J. Manthey*
Affiliation:
Institute of Clinical Psychology and Psychotherapy & Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187Dresden, Germany
P. Struzzo
Affiliation:
Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074Monfalcone, GO, Italy University of Trieste, Department of Life Sciences, Via Weiss 2, 34128Trieste, Italy
A. Gual
Affiliation:
Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036Barcelona, Catalonia, Spain Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036Barcelona, Catalonia, Spain Red de Trastornos Adictivos (RTA–RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036Barcelona, Catalonia, Spain
M. Wojnar
Affiliation:
Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665Warsaw, Poland Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI48109, USA
*
⁎Corresponding author. E-mail address:[email protected] (J. Manthey).
Get access

Abstract

Background

Alcohol use disorders (AUDs) are highly prevalent in Europe, but only a minority of those affected receive treatment. It is therefore important to identify factors that predict treatment in order to reframe strategies aimed at improving treatment rates.

Methods

Representative cross-sectional study with patients aged 18–64 from primary health care (PC, six European countries, n = 8476, data collection 01/13–01/14) and from specialized health care (SC, eight European countries, n = 1762, data collection 01/13–03/14). For descriptive purposes, six groups were distinguished, based on type of DSM-IV AUD and treatment setting. Treatment status (yes/no) for any treatment (model 1), and for SC treatment (model 2) were main outcome measures in logistic regression models.

Results

AUDs were prevalent in PC (12-month prevalence: 11.8%, 95% confidence interval (CI): 11.2–12.5%), with 17.6% receiving current treatment (95%CI: 15.3–19.9%). There were clear differences between the six groups regarding key variables from all five predictor domains. Prediction of any treatment (model 1) or SC treatment (model 2) was successful with high overall accuracy (both models: 95%), sufficient sensitivity (model 1: 79%/model 2: 76%) and high specificity (both models: 98%). The most predictive single variables were daily drinking level, anxiety, severity of mental distress, and number of inpatient nights during the last 6 months.

Conclusions

Variables from four domains were highly predictive in identifying treatment for AUD, with SC treatment groups showing very high levels of social disintegration, drinking, comorbidity and functional losses. Earlier intervention and formal treatment for AUD in PC should be implemented to reduce these high levels of adverse outcomes.

Keywords

Alcohol use disorderAlcohol dependenceTreatmentSpecialized carePrimary careEurope
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 8 , November 2015 , pp. 885 - 893
Copyright
Copyright © European Psychiatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Joint last authorship.

References

Alexander, L.M.. Guidelines for hypertension treatment: applications for primary care practice – a review of the JNC VI report. Lippincotts Prim Care Pract 1998;2:485–497.Google ScholarPubMed
Alonso, J.Angermeyer, M.C.Bernert, S.Bruffaerts, R.Brugha, T.S., ESEMeD/MHEDEA Investigators. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004;109:47–54.CrossRefGoogle Scholar
American Psychiatric Association, Diagnostic and statistical manual of mental disorders, [text revision] 4th ed, Washington, DC: American Psychiatric Association; 2000.Google Scholar
American Psychiatric Association. Substance use and addiction-related disorders. In: Diagnostic and statistical manual of mental disorders 5th ed, Arlington, VA: American Psychiatric Association; 2013. p. 481–589.Google Scholar
Andrén, K.G.Rosenqvist, U.. An ecological study of the relationship between risk indicators for social disintegration and use of a somatic emergency department. Soc Sci Med 1987;25:1121–1127.CrossRefGoogle ScholarPubMed
Australian Bureau of Statistics. Use of the Kessler Psychological Distress Scale in ABS Health Surveys, Australia, 2007–08; 2012.Google Scholar
Baruch, Y.. Survey response rate levels and trends in organizational research. Hum Relat 2008;61:1139–1160.CrossRefGoogle Scholar
Cohen, E.Feinn, R.Arias, A.Kranzler, H.R.. Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 2007;86:214–221.CrossRefGoogle ScholarPubMed
Colom, J.Scafato, E.Segura, L.Gandin, C.Struzzo, P.. Brief interventions implementation on alcohol from the European health systems perspective. Front Psychiatry 2014;5:161.CrossRefGoogle ScholarPubMed
Creavin, S.T.Creavin, A.L.Mallen, C.D.. Do GPs respond to postal questionnaire surveys? A comprehensive review of primary care literature. Fam Pract 2011;28:461–467.CrossRefGoogle ScholarPubMed
Culpepper, L.. Generalized anxiety disorder in primary care: emerging issues in management and treatment. J Clin Psychiatry 2002;63:35–42.Google ScholarPubMed
Dawson, D.A.Godstein, R.B.Grant, B.F.. Factors associated with first utilization of different types of care for alcohol problems. J Stud Alcohol Drugs 2012;73:647–656.CrossRefGoogle ScholarPubMed
Fagan, K.J.Irvine, K.M.Kumar, S.Bates, A.Horsfall, L.U.Feeney, G.F., et al.Assessment of alcohol histories obtained from patients with liver disease: opportunities to improve early intervention. Intern Med 2013;43:1096–1102.CrossRefGoogle ScholarPubMed
Farren, C.K.Snee, L.Daly, P.McElroy, S.. Prognostic factors of 2-year outcomes of patients with comorbid bipolar disorder or depression with alcohol dependence: importance of early abstinence. Alcohol Alcohol 2013;48:93–98.CrossRefGoogle ScholarPubMed
Finn, S.W.Bakshi, A.S.Andréasson, S.. Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence. Subst Use Misuse 2014;49:762–769.CrossRefGoogle Scholar
Fleiss, J.L.Levin, B.Cho Paik, M.Statistical methods for rates and proportions, 3rd ed, Hoboken, New Jersey: John Wiley & Sons; 2003.CrossRefGoogle Scholar
Furukawa, T.A.Kessler, R.C.Slade, T.Andrews, G.. The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med 2003;33:357–362.CrossRefGoogle ScholarPubMed
Garin, O.Ayuso-Mateos, J.L.Almansa, J.Nieto, M.Chatterji, S.Vilagut, G., et al.Validation of the World Health Organization Disability Assessment Schedule, WHODAS-2 in patients with chronic diseases. Health Qual Life Outcomes 2010;8:51.CrossRefGoogle ScholarPubMed
Garratt, A.M.Solheim, E.Danielsen, K.National and cross-national surveys of patient experiences: a structured review. Rapport No. 7-2008. Oslo: Nasjonalt Kunnskapssenter for Helsetjenesten; 2008.Google ScholarPubMed
Gossop, M.The treatment mapping survey: a descriptive study of drug and alcohol treatment responses in 23 countries. Drug Alcohol Depend 1995;39:7–14.CrossRefGoogle ScholarPubMed
Hasin, D.S.Stinson, F.S.Grant, B.F.Prevalence, correlates, disability and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2007;64:830–842.CrossRefGoogle ScholarPubMed
Hernán, M.A.Hernández-Díaz, S.Robins, J.M.A structural approach to selection bias. Epidemiology 2004;15:615–625.CrossRefGoogle ScholarPubMed
Higgins, J.P.Thompson, S.G.Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–1558.CrossRefGoogle ScholarPubMed
Jané-Llopis, E.Matytsina, I.Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2006;25:515–536.CrossRefGoogle ScholarPubMed
Kessler, R.C.Üstün, T.B.The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121.CrossRefGoogle Scholar
Kessler, R.C.Barker, P.R.Colpe, L.J.Epstein, J.F.Gfroefer, J.C.Hiripi, E., et al.Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184–189.CrossRefGoogle ScholarPubMed
Keyes, K.M.Hatzenbuehler, M.L.McLaughlin, K.A.Link, B.Olfson, M.Grant, B.F., et al.Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol 2010;172:1364–1372.CrossRefGoogle ScholarPubMed
Kohn, R.Saxena, S.Levav, I.Saraceno, B.The treatment gap in mental health care. Bull World Health Organ 2004;82:858–866.Google ScholarPubMed
Kraus, L.Piontek, D.Pfeiffer-Gerschel, T.Rehm, J.Inanspruchnahme gesundheitlicher Versorgung durch Alkoholabhängige Health care utilization of people with alcohol dependence. Suchttherapie 2015;16:18–26.Google Scholar
Lahmek, P.Berlin, I.Michel, L.Berghout, C.Meunier, N.Aubin, H.J.. Determinants of improvement in quality of life of alcohol-dependent patients during an inpatient withdrawal programme. Int J Med Sci 2009;6:160–167.CrossRefGoogle ScholarPubMed
Linde, K.Sigterman, K.Kriston, L.Rücker, G.Jamil, S.Meissner, K., et al.Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam Med 2015;13:56–68.CrossRefGoogle ScholarPubMed
Mäkelä, K.Arminen, I.Bloomfield, K.Eisenbach-Stangl, I.Bergmark, K.H.Kurube, N., et al.Alcoholics Anonymous as a mutual-help movement: a study in eight societies. Madison, WI: University of Wisconsin Press; 1996.Google Scholar
Manthey, J.Gual, A.Jakubczyk, A.Pieper, L.Probst, C.Struzzo, P., et al.Alcohol use disorders in Europe: a comparison of general population and primary health care prevalence rates. J Subst Use [in press].Google Scholar
Mojtabai, R.Chen, L.Y.Kaufmann, C.N.Crum, R.M.. Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders. J Subst Abuse Treat 2014;46:268–273.CrossRefGoogle ScholarPubMed
Neuhauser, H.Thamm, M.Ellert, U.. Blutdruck in Deutschland 2008–2011. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 2013;56:795–801.CrossRefGoogle Scholar
Nordström, G.Berglund, M.. Successful adjustment in alcoholism. Relationships between causes of improvement, personality, and social factors. J Nerv Ment Dis 1986;174:664–668.Google ScholarPubMed
Ormel, J.VonKorff, M.Üstün, T.B.Pini, S.Korten, A.Oldehinkel, T.. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994;272:1741–1748.CrossRefGoogle Scholar
Proudfoot, H.Teesson, M.Australian National Survey of Mental Health and Well-Being Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Well-Being. Soc Psychiatry Psychiatr Epidemiol 2002;37:451–456.CrossRefGoogle Scholar
Rehm, J.Allamani, A.Elekes, Z.Jakubczyk, A.Manthey, J.Probst, P., et al.Alcohol dependence and treatment utilization in Europe – a representative cross-sectional study in primary care. BMC Fam Pract 2015;16(1):90. http://dx.doi.org/10.1186/s12875-015-0308-8.CrossRefGoogle ScholarPubMed
Rehm, J.Roerecke, M.. Reduction of drinking in problem drinkers and all-cause mortality. Alcohol Alcohol 2013;48:509–513.CrossRefGoogle ScholarPubMed
Rehm, J.Room, R.Van den Brink, W.Jacobi, F.. Alcohol use disorders in EU countries and Norway: an overview of the epidemiology. Eur Neuropsychopharmacol 2005;15:377–388.CrossRefGoogle ScholarPubMed
Rehm, J.Shield, K.D.Rehm, M.X.Gmel, G. Jr.Frick, U.Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: potential gains from effective interventions for alcohol dependence. Toronto, Canada: Centre for Addiction and Mental Health; 2012.Google Scholar
Rehm, J.Shield, K.D.Rehm, M.X.Gmel, G.Frick, U.. Modelling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union. Eur Neuropsychopharmacol 2013;23:89–97.CrossRefGoogle Scholar
Rehm, J.Dawson, D.Frick, U.Gmel, G.Roerecke, M.Shield, K.D., et al.Burden of disease associated with alcohol use disorders in the United States. Alcohol Clin Exp Res 2014;38:1068–1077.CrossRefGoogle ScholarPubMed
Rehm, J.Anderson, P.Barry, J.Dimitrov, P.Elekes, Z.Feijão, F., et al.Prevalence of and potential influencing factors for alcohol dependence in Europe. Eur Addict Res 2015;21:6–18.CrossRefGoogle ScholarPubMed
Rehm, J.Allamani, A.Elekes, Z.Jakubczyk, A.Landsmane, I.Manthey, J., et al.General practitioners recognizing alcohol dependence: a large cross-sectional study in six European countries. Ann Fam Med 2015;13:28–32.CrossRefGoogle Scholar
Rehm, J.Allamani, A.Aubin, H.J.Elekes, Z.Frick, U.Jakubczyk, A., et al.People with alcohol use disorders in specialized care in eight different European countries. Alcohol Alcohol 2015;50:310–318.CrossRefGoogle ScholarPubMed
Roerecke, M.Rehm, J.. Alcohol use disorders and mortality – A systematic review and meta-analysis. Addiction 2013;108:1562–1578.CrossRefGoogle ScholarPubMed
Roerecke, M.Gual, A.Rehm, J.. Reduction of alcohol consumption and subsequent mortality in alcohol use disorders: systematic review and meta-analysis. J Clin Psychiatry 2013;74:e1181–e1189.CrossRefGoogle Scholar
Rothman, K.J.Greenland, S.Lash, T.L.Modern epidemiology, 3rd ed, Philadelphia, PA: Lippincott Williams & Wilkins; 2008.Google Scholar
Samokhvalov, A.V.Popova, S.Room, R.Ramonas, M.Rehm, J.. Disability associated with alcohol abuse and dependence. Alcohol Clin Exp Res 2010;34:1871–1878.CrossRefGoogle ScholarPubMed
Saunders, S.M.Zygowicz, K.M.D’Angelo, B.R.. Person-related and treatment-related barriers to alcohol treatment. J Subst Abuse Treat 2006;30:261–270.CrossRefGoogle ScholarPubMed
Schomerus, G.Lucht, M.Holzinger, A.Matschinger, H.Carta, M.G.Angermeyer, M.C.. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 2011;46:105–112.CrossRefGoogle ScholarPubMed
Shadish, W.R.Cook, T.D.Campbell, D.T.Experimental and quasi-experimental designs for generalized causal inference. New York, U.S.: Houghton Mifflin Company; 2002.Google Scholar
Sobell, L.C.Sobell, M.B.Toneatto, T.Leo, G.I.. What triggers the resolution of alcohol problems without treatment. Alcohol Clin Exp Res 1993;17:217–224.CrossRefGoogle ScholarPubMed
Sobell, L.C.Ellingstad, T.P.Sobell, M.B.. Natural recovery from alcohol and drug problems: methodological review of the research with suggestions for future directions. Addiction 2000;95:749–764.CrossRefGoogle ScholarPubMed
Spithoff, S.Kahan, M.. Primary care management of alcohol use disorder and at-risk drinking: part 2: counsel, prescribe, connect. Can Fam Physician 2015;61:515–521.Google ScholarPubMed
Stata Corporation. Stata Statistical Software (version 12). College Station, TX: Stata Corporation LP; 2011.Google Scholar
Üstün, B.T.Sartorius, N.Mental illness in general health care. An international study. West Sussex, England: John Wiley & Sons; 1995[published on behalf of World Health Organization].Google Scholar
Üstün, B.T.Compton, W.Mager, D.Babor, T.Baiyewu, O.Chatterji, S., et al.WHO study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results. Drug Alcohol Depend 1997;47:161–169.CrossRefGoogle Scholar
Üstün, T.Chatterji, S.Rehm, J.. Limitations of diagnostic aradigm: it doesn’t explain “need”. Arch Gen Psychiatry 1998;55:1145–1146.CrossRefGoogle Scholar
Üstün, T.B.Chatterji, S.Kostanjsek, N.Rehm, J.Kennedy, C.Epping-Jordan, J., et al.Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ 2010;88:815–823.CrossRefGoogle ScholarPubMed
Üstün, T.B.Kostanjsek, N.Chatterji, S.Rehm, J.Measuring Health and Disability. In: Manual for WHO Disability Assessment Schedule WHODAS 2.0. Geneva, Switzerland: World Health Organization; 2010.Google Scholar
Wittchen, H.U.. Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 1994;28:57–84.CrossRefGoogle ScholarPubMed
Wittchen, H.U.Glaesmer, H.März, W.Stalla, G.K.Lehnert, H.Zeiher, A.M., et al.Cardiovascular risk factors in primary care: methods and baseline prevalence rates – the DETECT program. Curr Med Res Opin 2005;21:619–629.CrossRefGoogle ScholarPubMed
Wittchen, H.U.Jacobi, F.Rehm, J.Gustavsson, A.Svensson, M.Jönsson, B., et al.The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:655–679.CrossRefGoogle ScholarPubMed
World Health Organization, The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993.Google Scholar
World Health Organization. Strengthening European health systems as a continuation of the WHO Regional Office for Europe's Country Strategy “Matching services to new needs”. In: Regional Committee for Europe: fifty-fifth session; 2005.Google Scholar
Supplementary material: File

Rehm et al. supplementary material

Supplementary materials

Download Rehm et al. supplementary material(File)
File 1.8 MB
Submit a response

Comments

No Comments have been published for this article.