December 16, 2019

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

Hey there, time traveller!
This article was published 25/6/2018 (538 days ago), so information in it may no longer be current.

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.

Dr. Nathan Nickel, assistant professor at the University of Manitoba and research scientist at the Manitoba Centre for Health Policy.

JOHN WOODS / WINNIPEG FREE PRESS

Dr. Nathan Nickel, assistant professor at the University of Manitoba and research scientist at the Manitoba Centre for Health Policy.

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.

25 years of data

Manitobans diagnosed with an "alcohol-use disorder" who have a physical disorder, such as liver damage, or a mental disorder, such as addiction, caused by high-risk alcohol use:

Manitobans diagnosed with an "alcohol-use disorder" who have a physical disorder, such as liver damage, or a mental disorder, such as addiction, caused by high-risk alcohol use:

  • Are more likely to die prematurely (before age 75): women are four times as like to die early as others in their group; men are three times as likely.
  • Women had 4.5 additional hospital visits and spent an additional 41 days in hospital.
  • Men had 2.9 additional hospital visits and spent 34.8 additional days in hospital.
  • Women had an ischemic heart disease (atherosclerosis) incident rate 2.92 times higher. For men, it was 3.59 times higher.
  • Women had close to twice the rate of alcohol-related cancer; men had nearly five times the rate.
  • Manitobans diagnosed with alcohol-use disorders were more than three times more likely to move into social housing.
  • Rates of charges for driving while intoxicated were 6.77 times higher for women and 4.96 times higher for men.
  • Women were 9.26 times more likely to have their children taken into care.
  • Women were 4.67 times more likely -- and men were 4.73 more likely -- to receive income assistance

"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."

What's considered high risk?

Click to Expand

Women should consume no more than 10 drinks per week, and no more than two drinks per day most days.

Men should consume no more than 15 drinks per week, and no more than three drinks per day on most days.

An estimated 19 per cent of Canadians and 16.8 per cent of Manitobans reported heavy drinking behaviours – defined for men as having five or more drinks in one sitting more than once a month. For women, it's having four or more drinks in one sitting more than once a month.

Eighty per cent of Canadians are considered low-risk drinkers.

-- source: Health and Social Outcomes Associated with High-Risk Alcohol Use report, by Manitoba Centre for Health Policy

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.

carol.sanders@freepress.mb.ca

Carol Sanders

Carol Sanders
Reporter

Carol Sanders’ reporting on newcomers to Canada has made international headlines, earned national recognition but most importantly it’s shared the local stories of the growing diversity of people calling Manitoba home.

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