53,000 diagnoses, 25 years of missed opportunities: Manitoba alcohol-use disorder study

Manitoba is doing “too little, too late” when it comes to its biggest problem drinkers, says the lead author of a Manitoba Centre for Health Policy study delving into 25 years of data.

Manitoba Health commissioned the ground-breaking study analyzing anonymous data focusing on 53,625 people diagnosed with an “alcohol-use disorder” between 1990 and 2015.

It found Manitobans diagnosed with a physical disorder, such as liver damage, or a mental disorder, such as addiction, caused by alcohol use are at their highest risk of dying within one year of diagnosis.

Four years before receiving such a diagnosis, the study found a gradual increase in subjects’ use of welfare, social housing and involvement with Child and Family Services. A year before a diagnosis, the justice system is often involved as a result of impaired driving and family violence, said the study, titled: Health and Social Outcomes Associated with High-Risk Alcohol Use.

“We’re identifying them well into their disease trajectory,” the study’s lead author, Nathan Nickel, said at a news conference Monday.

“If we could identify them sooner, and get them into treatment earlier, that might have an impact on reducing the mortality during that first year,” said Nickel, assistant professor of community health sciences at the University of Manitoba’s Max Rady College of Medicine.

“We are identifying them and doing too little, too late for these individuals, in many cases.”

The 150-page reported combed through data collected by the Manitoba Population Research Data Repository — a clearing house of information collected from provincial health-care, education, social service and justice systems.

One of the things the health-care system could do to help would be to more often prescribe medications, such as naltrexone, that curb alcohol cravings and dependence, said Nickel.

The study found only 493 out of the 53,625 individuals with an “alcohol-use disorder” (AUD) had a prescription dispensed for one of three major pharmacotherapies used to help treat it.

“We were struck by the extensive under-utilization of these drugs in Manitoba,” the report says. “Several studies have shown that these therapies are efficacious at reducing the symptoms of addiction. The low prescription prevalence in this population seems to be a missed opportunity for treating AUDs.”

The researchers initially set out to evaluate community treatment programs such as those offered by the Addictions Foundation of Manitoba, and to see what impact they have on the trajectory of high-risk alcohol users. They discovered they couldn’t, because such data can’t be found in the Manitoba Population Research Data Repository. Instead, researchers focused on pharmacotherapies available in the province, the report said.

Nickel said naltrexone has been added to the Manitoba drug benefits formulary that lists “therapeutically-effective drugs of proven high quality” that have been approved as eligible benefits under the Pharmacare drug-benefit program, so it should be more readily available to more people.

When the medication is provided with behavioural therapy, it has a chance of altering someone’s deadly alcohol abuse trajectory, he said.

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