Exploring the Prevalence and Impact of Alcohol Dependence

Find out how your peers responded to questions from this quiz about alcohol dependence.

Linda J. Frazier, M.A., R.N., M.C.H.E.S.

Note: A total of 1321 completed quizzes were received as of August 28, 2018.

The graphs below depict the percentage of respondents who incorrectly or correctly chose answer A, B, C, or D. The key at the bottom of each graph contains the multiple-choice answers for each question.

NOTE: Extended-release naltrexone is indicated for the treatment of “alcohol dependence,” in conjunction with psychosocial support. Patients should not be actively drinking at the time of initial VIVITROL administration. This diagnostic term is consistent with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. The diagnostic term “alcohol use disorder,” also used in this quiz, is consistent with the fifth edition of the DSM (DSM-5).

Question 1 of 5: According to data from the 2016 National Survey on Drug Use and Health (NSDUH), approximately ___ US adults were diagnosed with an alcohol use disorder in 2016.

Finding: More than one-quarter of respondents underestimated the prevalence of diagnosed alcohol use disorder. By contrast, about 75% of respondents appreciate that alcohol use disorder represents a substantial burden.

Commentary from Linda J. Frazier, M.A., R.N., M.C.H.E.S.*: It’s important for healthcare providers to realize that the DSM-5 definition of alcohol use disorder integrates the former DSM-IV definitions of both alcohol dependence and alcohol abuse and can be mild, moderate, or severe.

Explanation
Based on results from the 2016 NSDUH, in 2016 nearly 14.6 million US adults had alcohol use disorder, defined as alcohol dependence or alcohol abuse. This prevalence represented about 6% of the US population at that time.

For complete information, see:
Center for Behavioral Health Statistics and Quality. Results From the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.

Question 2 of 5: According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in 2010 the cost of emergency department visits for alcohol dependence among US adults aged 21 and older was approximately ___.

Finding: Nearly half of respondents underestimated the economic impact of emergency department visits for alcohol dependence.

Commentary from Ms. Frazier*: Increasing our patients’ appreciation of the potential health consequences of their alcohol use may ultimately help to decrease their need for emergency services related to alcohol use.

Explanation
According to NIAAA data, in 2010 the cost of emergency department visits for alcohol dependence among US adults aged 21 and older was approximately $640 million. Furthermore, the cost of hospital admissions for alcohol dependence in this population was approximately $474 million. These figures include data only from cases in which alcohol dependence was the primary reason for admission.

For complete information, see:
National Institute on Alcohol Abuse and Alcoholism. U.S. Alcohol Epidemiologic Data Reference Manual, Volume 9: Alcohol-Related Emergency Department Visits and Hospitalizations and Their Co-Occurring Drug-Related, Mental Health, and Injury Conditions in the United States: Findings From the 2006-2010 Nationwide Emergency Department Sample (NEDS) and Nationwide Inpatient Sample (NIS). Bethesda, MD: National Institutes of Health; 2013. NIH Publication No. 13-8000.

Question 3 of 5: Alcohol use disorder has been associated with a nearly ___-times-elevated all-cause mortality rate.

Finding: Nearly one-quarter of respondents underestimated the impact of alcohol use disorder on overall mortality rates.

Commentary from Ms. Frazier*: As noted in the DSM-5, alcohol use disorder is a treatable chronic condition, and recovery is possible. It’s important to convey information to patients about all of the health risks associated with heavy drinking, including its impact on the gastrointestinal tract, cardiovascular system, and nervous system.

Explanation
A prospective cohort and co-relative design study published in 2016 examined the excess mortality associated with alcohol use disorder. The study included all individuals born in Sweden from 1940 to 1965 who had neither died nor migrated before 1973 or age 15. The people were followed up on from 1973 through 2010. The alcohol use disorder mortality rate of 5.83 was estimated using a Cox proportional hazard model, which accounted for covariates of patient sex, educational status, and year of birth.

For complete information, see:
Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Alcohol use disorder and mortality across the lifespan: a longitudinal cohort and co-relative analysis. JAMA Psychiatry. 2016;73(6):575-581.

Question 4 of 5: According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which of the following individuals would exceed the limits of “low-risk” drinking?

Finding: Most respondents appear to understand the NIAAA’s definitions of drinking risk levels. However, about 1 in 10 respondents do not.

Commentary from Ms. Frazier*: It’s encouraging that most healthcare professionals who took this quiz understand the limits of low-risk drinking. We should help ensure that patients understand these limits as well.

Explanation
Alcohol use levels are defined differently for men and women. According to the NIAAA, women who have more than 3 drinks on any single day or more than 7 drinks per week are at risk for developing an alcohol use problem. Men who have more than 4 drinks on any single day or more than 14 drinks per week are considered to be at risk for developing an alcohol use problem.

For complete information, see:
National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed March 12, 2018.

Question 5 of 5: According to data from the 2016 National Survey on Drug Use and Health (NSDUH), of the approximately 15 million US adults who needed treatment for an alcohol problem in the previous year, what percentage received it?

Finding: Most respondents were aware that only a small fraction of Americans with an alcohol problem actually receive treatment.

Commentary from Ms. Frazier*: For patients to realistically assess their need for treatment and guidance from a healthcare professional, they must understand how low-risk alcohol consumption is defined, as noted above, as well as the potential health consequences of heavy drinking.

Explanation
According to results from the 2016 NSDUH, approximately 8% of the US adults who needed treatment for an alcohol problem in the previous year received it. In this survey, treatment settings included inpatient hospital care, inpatient or outpatient drug and alcohol rehabilitation facilities, and mental health centers.

For complete information, see:
Center for Behavioral Health Statistics and Quality. Results From the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.


*Member of the Meeting the Need Steering Committee and paid consultant of Alkermes, Inc.
The safety and efficacy of VIVITROL® (naltrexone for extended-release injectable suspension) have not been established in individuals under the age of 18.


For more information on the treatment of alcohol dependence, view a practice guideline from the American Psychiatric Association.


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IMPORTANT SAFETY INFORMATION

INDICATIONS

VIVITROL is indicated for:

  • Treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL. Patients should not be actively drinking at the time of initial VIVITROL administration.
  • Prevention of relapse to opioid dependence, following opioid detoxification.
  • VIVITROL should be part of a comprehensive management program that includes psychosocial support.

CONTRAINDICATIONS

VIVITROL is contraindicated in patients:

  • Receiving opioid analgesics
  • With current physiologic opioid dependence
  • In acute opioid withdrawal
  • Who have failed the naloxone challenge test or have a positive urine screen for opioids
  • Who have exhibited hypersensitivity to naltrexone, polylactide-co-glycolide (PLG), carboxymethylcellulose, or any other components of the diluent

WARNINGS AND PRECAUTIONS

Vulnerability to Opioid Overdose:

  • After opioid detoxification, patients are likely to have a reduced tolerance to opioids. VIVITROL blocks the effects of exogenous opioids for approximately 28 days after administration. As the blockade wanes and eventually dissipates completely, use of previously tolerated doses of opioids could result in potentially life-threatening opioid intoxication (respiratory compromise or arrest, circulatory collapse, etc.).
  • Cases of opioid overdose with fatal outcomes have been reported in patients who used opioids at the end of a dosing interval, after missing a scheduled dose, or after discontinuing treatment. Patients and caregivers should be told of this increased sensitivity to opioids and the risk of overdose.
  • Although VIVITROL is a potent antagonist with a prolonged pharmacological effect, the blockade produced by VIVITROL is surmountable. The plasma concentration of exogenous opioids attained immediately following their acute administration may be sufficient to overcome the competitive receptor blockade. This poses a potential risk to individuals who attempt, on their own, to overcome the blockade by administering large amounts of exogenous opioids.
  • Any attempt by a patient to overcome the VIVITROL blockade by taking opioids may lead to fatal overdose. Patients should be told of the serious consequences of trying to overcome the opioid blockade.

Injection Site Reactions:

  • VIVITROL must be prepared and administered by a healthcare provider.
  • VIVITROL injections may be followed by pain, tenderness, induration, swelling, erythema, bruising, or pruritus; however, in some cases injection site reactions may be very severe.
  • Injection site reactions not improving may require prompt medical attention, including, in some cases, surgical intervention.
  • Inadvertent subcutaneous/adipose layer injection of VIVITROL may increase the likelihood of severe injection site reactions.
  • Select proper needle size for patient body habitus, and use only the needles provided in the carton.
  • Patients should be informed that any concerning injection site reactions should be brought to the attention of their healthcare provider.

Precipitation of Opioid Withdrawal:

  • When withdrawal is precipitated abruptly by administration of an opioid antagonist to an opioid-dependent patient, the resulting withdrawal syndrome can be severe. Some cases of withdrawal symptoms have been severe enough to require hospitalization, and in some cases, management in the ICU.
  • To prevent occurrence of precipitated withdrawal, opioid-dependent patients, including those being treated for alcohol dependence, should be opioid-free (including tramadol) before starting VIVITROL treatment:
    • – An opioid-free interval of a minimum of 7–10 days is recommended for patients previously dependent on short-acting opioids.
      – Patients transitioning from buprenorphine or methadone may be vulnerable to precipitated withdrawal for as long as two weeks.
  • If a more rapid transition from agonist to antagonist therapy is deemed necessary and appropriate by the healthcare provider, monitor the patient closely in an appropriate medical setting where precipitated withdrawal can be managed.
  • Patients should be made aware of the risk associated with precipitated withdrawal and be encouraged to give an accurate account of last opioid use.

Hepatotoxicity:

  • Cases of hepatitis and clinically significant liver dysfunction have been observed in association with VIVITROL. Warn patients of the risk of hepatic injury; advise them to seek help if experiencing symptoms of acute hepatitis. Discontinue use of VIVITROL in patients who exhibit acute hepatitis symptoms.

Depression and Suicidality:

  • Alcohol- and opioid-dependent patients taking VIVITROL should be monitored for depression or suicidal thoughts. Alert families and caregivers to monitor and report the emergence of symptoms of depression or suicidality.

When Reversal of VIVITROL Blockade Is Required for Pain Management:

  • For VIVITROL patients in emergency situations, suggestions for pain management include regional analgesia or use of non-opioid analgesics. If opioid therapy is required to reverse the VIVITROL blockade, patients should be closely monitored by trained personnel in a setting staffed and equipped for CPR.

Eosinophilic Pneumonia:

  • Cases of eosinophilic pneumonia requiring hospitalization have been reported. Warn patients of the risk of eosinophilic pneumonia and to seek medical attention if they develop symptoms of pneumonia.

Hypersensitivity Reactions:

  • Patients should be warned of the risk of hypersensitivity reactions, including anaphylaxis.

Intramuscular Injections:

  • As with any intramuscular injection, VIVITROL should be administered with caution to patients with thrombocytopenia or any coagulation disorder.

Alcohol Withdrawal:

  • Use of VIVITROL does not eliminate nor diminish alcohol withdrawal symptoms.

ADVERSE REACTIONS

  • The adverse events seen most frequently in association with VIVITROL therapy for alcohol dependence (ie, those occurring in ≥5% and at least twice as frequently with VIVITROL than placebo) include nausea, vomiting, injection site reactions (including induration, pruritus, nodules, and swelling), arthralgia, arthritis, or joint stiffness, muscle cramps, dizziness or syncope, somnolence or sedation, anorexia, decreased appetite or other appetite disorders.
  • The adverse events seen most frequently in association with VIVITROL in opioid-dependent patients (ie, those occurring in ≥2% and at least twice as frequently with VIVITROL than placebo) were hepatic enzyme abnormalities, injection site pain, nasopharyngitis, insomnia, and toothache.

You are encouraged to report side effects to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

See Prescribing Information and Medication Guide.