Public health

Radical changes needed to address alcohol disorders


A leading gastroenterologist has called for radical changes to the way alcohol abuse is treated in Australia.

These sweeping changes could include stripping patients of social security benefits unless they seek treatment, and significant injection of State and Federal funding to provide more treatment pathways.

Professor Jane Andrews made the comments to the limbic this week while talking about a recent article she co-authored on alcoholic liver disease (ALD) that was published in the Internal Medicine Journal.

She conceded her comments would probably be controversial, but she says they are necessary if there is to be any hope of change.

“I think there should aim to be some compulsion in treatment from the first admission, and a tying of benefits to ongoing treatment,” she said.

“It’s not about punishing people, but if you have a serious alcohol disorder you should be engaging in treatment.”

Professor Andrews is Head of Inflammatory Bowel Disease Service and Education at the Royal Adelaide Hospital’s Department of Gastroenterology and Hepatology.

She and her colleagues carried out a retrospective case-controlled cohort study at Royal Adelaide Hospital, to quantify the cost of inpatient care for ALD.

All admissions for ALD and other chronic liver disease (CLD) in a three-month period were retrospectively identified and examined for length of stay (LoS), mortality, inpatient costs, blood product utilisation and discharge destination.

Of 71 admissions due to CLD, ALD was the most frequent cause (53/71, 75%). ALD admissions cost more (median $10,100 vs. $5,294; p=0.0012) and had greater LoS (median LoS 7.2 days [IQR 0.2-40.7]) than controls (2.6 days [IQR 1.1 – 6.8]; p=0.0001).

A larger proportion of the ALD cohort required blood transfusion and had a higher mortality than controls (24.5% vs. 6.4%, p = 0.002 and 13.2% vs. 0.2%; p < 0.0001 respectively). Self-discharge was more common in the ALD group (13.2% vs. 1.1%, p < 0.0001).

“ALD inpatient hospital admissions have greater median total cost, longer LoS, greater blood product utilisation, higher mortality and greater rate of discharge against medical advice than age and gender-matched controls,” the authors concluded.

“These data emphasise the large inpatient care burden, high mortality and suboptimal engagement in those with ALD, which justifies more active provision of services for ALD.”

The researchers also found that ALD admissions had increased by 20% between 1993-2005.

Professor Andrews told the limbic physicians were frustrated by the constant flow of relatively young patients presenting to hospitals with cirrhosis from alcohol abuse.

The youngest patients she has seen are in their late 20s, although this is unusual, and the bulk are in their mid 30s.

“These are people dying in their 40s and 50s – it should not be happening,” she said.

She was critical of the amount of money poured into “hugely expensive drug therapy”, like Hepatitis C, when so little was directed at the treatment of alcohol-related disorders.

She said many patients with alcohol-related disorders also had mental health issues, and she was certain mental health services would “love to be better resourced” to help with treatment programs.

“There’s a culture fix that has to happen at a clinical level, but there also needs to be a political will – State and Federal Governments need to talk to each other and free up the funds to make it happen,” she said.

But patients would also need to be more motivated to get treatment. In a similar way to the linking of Family Tax benefits to childhood immunisation, Professor Andrews wants to see Centrelink benefits restricted to patients who refuse treatment for alcohol disorders.

“If you are in receipt of benefits these perhaps need to be curtailed until you commit to a treatment program and stick with it,” she said.

“It sounds terrible but we have to do something. It’s good to see the data support what we are seeing on the ground but we need to have better funding of alcohol services.”

 

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