Treatment for alcohol addiction falls short: study
System must ensure support continues after ER visits, co-author says
One in 20 people who go to an emergency department in Ontario for alcohol-related reasons die within a year of their second ER visit, according to a new study by ICES and the Centre for Addiction and Mental Health.
One of the study’s authors said the findings point to a failure of the health-care system to properly intervene and help those dealing with alcohol addiction before it’s too late.
“I was very struck by the findings,” said study co-author Dr. Paul Kurdyak, a psychiatrist and scientist at CAMH and ICES (formerly the Institute for Clinical Evaluative Sciences.)
The study, released Monday in the Canadian Medical Association Journal to coincide with National Addictions Awareness Week, examined about 25,800 people aged 16 and up between 2010 and 2016 who went to emergency departments in Ontario solely for alcohol-related mental or behavioural disorders. Overall, 5.4 per cent died within a year of their second or more ER visit.
Among those who died, the majority were men between the ages of 45 and 65, and those living in urban centres and lower-income neighbourhoods. This cohort was also more likely to have three to five or more visits to the emergency department during the span of the study.
Kurdyak said the findings reveal the need for a better system that ensures these individuals access to addiction support after they present themselves to emergency physicians, instead of losing track of their recovery.
“We kind of help them over the acute withdrawal management and they go on their way,” Kur
dyak said. Physicians will often give these patients referrals for addiction treatment, but it’s up to the patients themselves to follow up, and whether they do or not is not often tracked by anyone.
“This study made us all think that (referrals) are probably not good enough,” Kurdyak said. He added that because of the vulnerability of those dealing with alcohol addiction, barriers to finding treatment need to be lowered.
The findings have left Kurdyak and his co-authors wondering: “Can we really do a better job of getting these people engaged in care that goes beyond making referrals and handing them a piece of paper with a phone number?”
Kurdyak added that patients who go to the emergency department for alcohol-use are usually in a state of acute intoxication during their visit, and may not remember much about their encounter with the emergency physician.
“We need to do more work on their behalf to make sure they go where they need to go,” he said, adding input is needed from addiction medicine experts as well to envision what is referred to as a “warmer handoff” from emergency physicians to addiction treatment.
For those who prematurely die, the study found the cause of death for the majority is suicide or what is classified as an “accident,” which Kurdyak said could mean a broad range of incidents, including an opioid overdose where it’s not clear whether or not it was done intentionally.
Aside from bringing attention to mortality rates for those who access addiction treatment in the ER, Kurdyak said the study also hopes to shed light on the issue of alcohol use in general, and that it continues to be a public health issue with alarming consequences.
Much of the focus from a policy and research perspective from 2016 onwards has been on the opioid crisis, as fatal and toxic drugs like fentanyl and carfentani l began to widely emerge, Kurdyak said.
“But we also know that alcohol has also been an epidemic forever.”
Research shows that hospitalizations for alcohol-related illnesses outnumber those for heart attacks in Canada, and alcohol-related injuries cost Canadians approximately $14.6 billion annually — only $3.3 billion of that is health-care costs.
Another worry, Kurdyak added, is that his study predates the COVID-19 pandemic, which has led to higher rates of frequent alcohol consumption among the population, partly due to increased social isolation, according to several surveys and studies conducted since March.
Overall, Kurdyak said he hopes the study will bring attention to those who battle alcohol addiction — an addiction that is common with a high mortality rate — and inspire better policy and treatment options for them in the future.
“They deserve our attention,” Kurdyak said.