Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care

doi:10.1186/s12875-015-0308-8

. 2015 Jul 29:16:90.

doi: 10.1186/s12875-015-0308-8.

Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care

Jürgen Rehm^{1

2

3

4

5}, Allaman Allamani⁶, Zsuzsanna Elekes⁷, Andrzej Jakubczyk⁸, Jakob Manthey⁹, Charlotte Probst¹⁰, Pierluigi Struzzo^{11

12}, Roberto Della Vedova^{13

14}, Antoni Gual^{15

16

17}, Marcin Wojnar^{18

19}

Affiliations

¹ Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.
² Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada. jtrehm@gmail.com.
³ Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada. jtrehm@gmail.com.
⁴ Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.
⁵ Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jtrehm@gmail.com.
⁶ Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Via Pietro Dazzi 1, 50141, Firenze, Italy. allamana@gmail.com.
⁷ Corvinus University of Budapest, Közraktár u. 4-6, H-1093, Budapest, Hungary. elekesdr@gmail.com.
⁸ Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. and344@wp.pl.
⁹ Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jakobmanthey@snappyquest.org.
¹⁰ Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. charlotte.probst@tu-dresden.de.
¹¹ Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. pstruzzo@gmail.com.
¹² Department of Life Sciences, University of Trieste, Via Weiss, 2, 34128, Trieste, Italy. pstruzzo@gmail.com.
¹³ Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. roberto.dellavedova@tin.it.
¹⁴ Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052, Monza (MI), Italy. roberto.dellavedova@tin.it.
¹⁵ Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
¹⁶ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
¹⁷ Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
¹⁸ Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. marcin.wojnar@wum.edu.pl.
¹⁹ Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA. marcin.wojnar@wum.edu.pl.

PMID: 26219430
PMCID: PMC4518612
DOI: 10.1186/s12875-015-0308-8

Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care

Jürgen Rehm et al. BMC Fam Pract. 2015.

. 2015 Jul 29:16:90.

doi: 10.1186/s12875-015-0308-8.

Authors

Affiliations

¹ Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.
² Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada. jtrehm@gmail.com.
³ Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada. jtrehm@gmail.com.
⁴ Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.
⁵ Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jtrehm@gmail.com.
⁶ Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Via Pietro Dazzi 1, 50141, Firenze, Italy. allamana@gmail.com.
⁷ Corvinus University of Budapest, Közraktár u. 4-6, H-1093, Budapest, Hungary. elekesdr@gmail.com.
⁸ Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. and344@wp.pl.
⁹ Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jakobmanthey@snappyquest.org.
¹⁰ Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. charlotte.probst@tu-dresden.de.
¹¹ Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. pstruzzo@gmail.com.
¹² Department of Life Sciences, University of Trieste, Via Weiss, 2, 34128, Trieste, Italy. pstruzzo@gmail.com.
¹³ Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. roberto.dellavedova@tin.it.
¹⁴ Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052, Monza (MI), Italy. roberto.dellavedova@tin.it.
¹⁵ Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
¹⁶ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
¹⁷ Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
¹⁸ Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. marcin.wojnar@wum.edu.pl.
¹⁹ Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA. marcin.wojnar@wum.edu.pl.

PMID: 26219430
PMCID: PMC4518612
DOI: 10.1186/s12875-015-0308-8

Abstract

Background: Alcohol dependence (AD) in Europe is prevalent and causes considerable health burden. Recognition by general practitioners (GPs) and provision of or referral to treatment may contribute to reduce this burden. This paper studied AD prevalence in varying European primary care settings and examined who received treatment.

Methods: In a cross-sectional multi-centre study in six European countries, 358 general practitioners assessed 13,003 primary care patients between January 2013 and January 2014, of which 8,476 patients were interviewed, collecting information on socio-demographics, physical and mental problems, and on alcohol use, problems and treatment. AD diagnoses were determined by GPs' clinical judgement and a standardized interview. A wide definition for AD treatment included individual and group interventions provided by different health professionals. Descriptive as well as inferential statistics were employed.

Results: AD was prevalent among patients in European primary health care settings (8.7 %, 95 % confidence interval (CI): 8.1-9.3 %). Treatment rates were low (22.3 % of all AD cases, 95 % CI: 19.4-25.2 %). For both prevalence and treatment utilization, considerable country variations were observed. AD was associated with a number of socio-economic disadvantages (e.g. higher unemployment rate) and higher physical (e.g., liver disease, hypertension) and mental comorbidities (e.g., depression, anxiety). Liver problems, mental distress and daily amount of alcohol used were higher among treated versus untreated male patients with AD.

Conclusion: A minority of people identified as having AD received treatment, showing heavier drinking patterns and a higher level of co-morbidity. Different types of treatment, depending on severity of AD, should be considered.

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Figures

**Fig. 1**
Prevalence of alcohol dependence diagnoses by GP or CIDI, stratified by age categories. Figure displaying age effect on alcohol dependence categories. Legend: (*Blue bars*) Diagnosis by GP, (*Red bars*) Diagnosis by CIDI, (*Dashed line*) Regression line GP diagnosis, (*Continuous line*) Regression line CIDI diagnosis

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References

1. Rehm J, Shield KD, Rehm MX, 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(2):89–97. doi: 10.1016/j.euroneuro.2012.08.001. - DOI - PubMed
1. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol use disorders. Lancet. 2009;373(9682):2223–33. doi: 10.1016/S0140-6736(09)60746-7. - DOI - PubMed
1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) Washington, DC: American Psychiatric Association; 2000.
1. Samokhvalov AV, Popova S, Room R, Ramonas M, Rehm J. Disability associated with alcohol abuse and dependence. Alcohol Clin Exp Res. 2010;34(11):1871–8. doi: 10.1111/j.1530-0277.2010.01275.x. - DOI - PMC - PubMed
1. Roerecke M, Rehm J. Alcohol use disorders and mortality - A systematic review and meta-analysis. Addiction. 2013;108(9):1562–78. doi: 10.1111/add.12231. - DOI - PubMed

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[1] Rehm J, Shield KD, Rehm MX, 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(2):89–97. doi: 10.1016/j.euroneuro.2012.08.001. - DOI - PubMed

[2] Rehm J, Shield KD, Rehm MX, 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(2):89–97. doi: 10.1016/j.euroneuro.2012.08.001. - DOI - PubMed

[3] Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol use disorders. Lancet. 2009;373(9682):2223–33. doi: 10.1016/S0140-6736(09)60746-7. - DOI - PubMed

[4] Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol use disorders. Lancet. 2009;373(9682):2223–33. doi: 10.1016/S0140-6736(09)60746-7. - DOI - PubMed

[5] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) Washington, DC: American Psychiatric Association; 2000.

[6] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) Washington, DC: American Psychiatric Association; 2000.

[7] Samokhvalov AV, Popova S, Room R, Ramonas M, Rehm J. Disability associated with alcohol abuse and dependence. Alcohol Clin Exp Res. 2010;34(11):1871–8. doi: 10.1111/j.1530-0277.2010.01275.x. - DOI - PMC - PubMed

[8] Samokhvalov AV, Popova S, Room R, Ramonas M, Rehm J. Disability associated with alcohol abuse and dependence. Alcohol Clin Exp Res. 2010;34(11):1871–8. doi: 10.1111/j.1530-0277.2010.01275.x. - DOI - PMC - PubMed

[9] Roerecke M, Rehm J. Alcohol use disorders and mortality - A systematic review and meta-analysis. Addiction. 2013;108(9):1562–78. doi: 10.1111/add.12231. - DOI - PubMed

[10] Roerecke M, Rehm J. Alcohol use disorders and mortality - A systematic review and meta-analysis. Addiction. 2013;108(9):1562–78. doi: 10.1111/add.12231. - DOI - PubMed

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Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care

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Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care

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