Alcohol-Related Deaths in Scotland: Care for People with Dependence is Available, but High-Quality Care Is Lacking

Alcohol-related death rates have increased in some countries, including Scotland. Researchers there sought to determine whether primary-care interventions or other opportunities might have prevented the deaths. They analyzed 2003 death records from a large metropolitan area and identified 501 alcohol-related deaths (average age at death, 57.5 years; 72% men). They then conducted a comprehensive review of lifetime primary-care, inpatient (medical and psychiatric), social-work, forensic, charity, and police records for a subsample of 65 decedents (74% men). Actual care received by this subsample was compared with evidence-based recommendations for the management of alcohol use disorders.

• The majority of deaths were due to alcoholic liver disease (58%) and alcohol-related psychiatric disorders (14%).

• There were 24 lifetime primary-care or hospital outpatient visits among men and only 5 among women.

• Seventy-nine percent of patients received advice to abstain from alcohol.

• Twenty-three percent received brief interventions, but only 17% complied.

• Fifty-eight percent were referred to specialized treatment, but compliance was poor.

Comments:

This retrospective study suggests individuals who died from alcohol-related causes did not receive evidence-based care despite ample contact with clinical and other services. The findings are consistent with other research showing that only a small minority of individuals with alcohol use disorders receive high-quality evidence-based care. It is difficult to draw other conclusions from this study due to the small, single-city subsample and sampling of only decedents.

Kevin L. Kraemer, MD, MSc

Reference:

Morris M, Johnson D, Morrison DS. Opportunities for prevention of alcohol-related death in primary care: results from a population-based cross-sectional study. Alcohol. 2012;46(7):703–707.