Alcohol Use Disorder

• Autor(a) principal: Pinto, Augusto
• Data de Publicação: 2016
• Outros Autores: Fontes Ribeiro, Carlos, Vilar, Graça, Lázaro, José Carlos, Aranda da Silva, José, Trigoso, José Miguel, Cardoso, Manuel, Castro, Mário, Gouveia, Miguel, Vasconcelos, Miguel, Tato Marinho, Rui
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25756/rpf.v8i1.92

Alcohol-use disorders (AUD) are a serious public health problem with significant social and economic impact. It is therefore important to discuss the need for a paradigm shift regarding the approach and treatment of AUD. The 5th edition of the «Diagnostic and Statistical Manual of Mental Disorders» (DSM-V) discarded the distinction between harmful alcohol use and alcohol dependence, integrating these concepts into AUD, defined as a pattern of harmful alcohol consumption that leads to weakened health status and clinically significant distress.Alcohol misuse is a threat to global public health and is a major cause of mortality and morbidity. According to the WHO report, in 2011, excessive alcohol consumption accounted for 5.9% of all global deaths (about 3.3 million deaths) and 5.1% of the global burden of disease (as measured in disability-adjusted life years). In Europe the annual alcohol consumption per capita was 10.9 liters of pure alcohol, higher than the world average (6.2 liters of pure alcohol), whereas Portugal presented an annual consumption per capita of 12.9 liters of pure alcohol. The prevalence of AUD in Portugal, in 2010, was 5.8%, which was below the average for the WHO European Region (7.5%). It should be noted that, in Europe, alcohol use is the third leading risk factor of disease and premature death, following smoking and high blood pressure. A Portuguese study showed that about 3.8% of mortality is attributable to alcohol consumption, with higher incidence in men (5.6%) than in women (1.8%). Alcohol is responsible for a large number of diseases and health problems, and also for a high incidence of years of life lost at younger ages in traffic accidents. Alcohol use has also a hazardous effect to both consumer and others, as it has been shown that there is an association between alcohol use and the prevalence of crime in different social contexts. Furthermore, AUD is also a condition associated with high health costs. In Portugal it was estimated a total of costs of 1 916 million euros in outpatient and hospitalization health care for alcohol related illnesses in 2005. Nevertheless, the percentage of individuals receiving treatment for this condition remains low, since it is estimated that only 8% of patients with alcohol dependence in Europe are treated. One of the main barriers to the treatment is the patients’ reluctance to commit to abstinence, and, on the other hand, abstinence programs have a reduced effectiveness, with 70% to 80% relapses within the first year after treatment. Recent guidelines recommend intervention strategies that focus on reducing harmful drinking and the minimization of problems linked to alcohol use and alcohol misuse. These are possible alternatives to programs that aim for abstinence, especially in situations when patients´ monitoring is, to some degree, dependent of alcohol use.Overall, intervention in harmful alcohol use will improve national indicators regarding the number of years of healthy life and will have a strong positive social impact, as the episodes of domestic violence, homicides, traffic accidents and injuries caused under the influence of alcohol should decrease. Nonetheless, it is necessary to focus on prevention strategies, particularly amongst young people, to effectively combat the negative effects of alcohol misuse in society. In order to tackle this challenge, it is important to prepare primary health care with the means necessary for early AUD detection and adequate response to the needs of patients. Additionally, the implementation of strategies and comprehensive policies, involving the state, society, health professionals and patients is critical for a successful approach. On the other hand, it must be ensured that the availability, sale, access and use of alcohol are safe and that harmful alcohol use is not encouraged, by providing proper education, implementing appropriate regulation and supervision of alcohol use. This reflection meeting has called attention to the need to position AUD on the political agenda as a major public health problem in Portugal.