Expanding the Role of Health Services Research as a Tool to Reduce the Public Health Burden of Alcohol Use Disorders

Abstract

The public and private cost of “heavy alcohol use” ¹ is estimated to be more than 187 billion in lost productivity, health care and criminal justice expenditures, and other costs. This does not include the emotional and psychological costs to family, friends, and the community. Investments by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have led to a number of important advances in pharmacological and behavioral treatments for alcohol disorders. Yet, there continues to be a significant gap between research findings and progress in community-based care. Additionally, limited capacity, a lack of acknowledged standards, and a separation between the specialty substance use treatment sector and general medical practice contribute to this gap. As part of its ongoing efforts to encourage translation from clinical research to practice, NIAAA undertook a review of its alcohol related health services research program for the purpose of creating a vision for the next 10 yr that is sensitive to the changing needs of both the clinical and research communities. Central to the development of a new research agenda is a reconceptualization of alcohol use and misuse along a continuum that takes into account quantity and frequency of use as well as the consequences from “heavy use” and misuse of alcohol. This public health approach recommends a number of high priority areas to expand and improve the system of care for “heavy alcohol users” who may be at-risk or who may have developed an alcohol use disorder. These recommendations include research on dissemination and implementation of evidence-based practices, and improving access and utilization to care for individuals who are “heavy users.” The paper concludes by outlining some of the steps taken by NIAAA to further the continuing development of alcohol health services research.

¹ The terms heavy alcohol use(rs), which are often used in the literature, are an unscientific taxonomy which is bounded (culture, time, and place, etc.) and which inadvertently homogenizes a heterogeneous population of alcoholic beverage consumers and patterns of use. Editor's note.

Keywords:

• health services
• alcohol user treatment
• alcohol diagnosis
• context of treatment

Notes

¹ The terms heavy alcohol use(rs), which are often used in the literature, are an unscientific taxonomy which is bounded (culture, time, and place, etc.) and which inadvertently homogenizes a heterogeneous population of alcoholic beverage consumers and patterns of use. Editor's note.

^a Adapted from Hasin et al., 2007.

² This includes no more than 4 drinks in a day AND no more than 14 drinks in a week for healthy adult men up to age 65 and no more than 3 drinks in a day AND no more than 7 drinks in a week for healthy adult women (and healthy men over age 65). NIAAA clinician's guide for helping people who drink too much, 2005.

³ For a complete copy of the alcohol health services review and EAB recommendations, the reader is directed to http://www.niaaa.nih.gov/ResearchInformation/ExtramuralResearch/AdvisoryCouncil/default.htm.