A robust 25-year study suggests the key to helping Manitobans in the grips of alcohol disorders could be all about more timely diagnoses and removing barriers to prescriptions and treatment so those with addictions can get quicker access to care.
“We’re reaching these people, these individuals too late,” said Dr. Nathan Nickel, lead author of the Health and Social Outcomes Associated with High-Risk Alcohol Use study.
“They’ve already progressed along their disease trajectory and missing them is having fatal consequences.”
Dr. Alan Katz, director of the Manitoba Centre for Health Policy at the University of Manitoba, called it a “sobering report.” It followed 53,000 Manitobans — 64 per cent men, 36 per cent women — diagnosed with alcohol disorders between 1990 and 2015.
Unlike other studies, this one pooled data on those individuals’ contact not just with the health-care system, but also with child and family services, justice, income assistance and social housing systems.
Those with mental health issues and physical illnesses including liver damage were more likely to be struggling with alcohol addiction than the average Manitoban, as were younger, low-income people.
The research, commissioned by Manitoba Health, showed what past studies have revealed in terms of how much more often those with diagnosed alcohol disorders access hospitals and emergency rooms. The Manitoba subjects were accessing those services five times more often than the general population, said Nickel.
Nickel said he was shocked to find that those diagnosed with an alcohol disorder had a five-times higher rate of dying within one year of being diagnose.
But it’s the early mark these people leave on other forms of social supports that was previously invisible.
“Even four years before someone received their diagnosis they started to use an increasing amount of social services, such as income assistance and social housing,” said Nickel. “In many cases we saw a significant spike in social services use and interactions with the justice system a full year before someone received their diagnosis.
“We saw a very similar pattern when we looked at the emergency department,” he said.
Nickel said those findings point to issues accessing treatment and prescription medication in the early stages of addictions.
Manitoba women in particular have a challenging time accessing treatment quickly, according to the Manitoba Mental Health and Addictions Strategy released in May.
For women, Health Canada defines anything more than two drinks per sitting or 10 drinks in a week as high risk behaviour. The guidelines for men are three drinks in one sitting or 15 per week.
The World Health Organization has a set of brief interventions it encourages family doctors to offer during patient visits. They include a series of questions designed to identify high risk drinking or harmful drinking.
Manitoba doctors aren’t doing a good enough job of performing that test, Nickel says, and that could be allowing problem drinking to go on below the surface and increase health risks for patients.
Fewer than two per cent of those with diagnosed alcohol disorders were provided medications proven to help reduce alcohol dependency, and the problem was even more stark for the poor.
Low-income people were “far less likely” to be prescribed helpful medications for alcohol disorders compared to high-income Manitobans, Nickel said.
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Naltrexone is one of the most common such medications and has the highest success rate of reducing alcohol dependency when paired with behavioural therapy.
Manitoba recently added alcohol to its formulary, which Nickel hopes will mean more of those in the grips of addiction will be able to access medication and reduce some of the associated harms.
Nickel said there are already inter-departmental working groups looking at how to better co-ordinate mental health and addictions services in Manitoba.
He said researchers are also partnering with First Nations to be able to look more deeply into how issues like institutionalized racism and colonialism contribute to alcoholism among Indigenous people.