Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont.
CMAJ. 2023 Oct 16;195(40):E1364-E1379. doi: 10.1503/cmaj.230715.
In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder.
Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders.
The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes.
The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.
在加拿大，医疗保健提供者和可能从中受益的人群对酒精使用障碍的循证干预措施的认识水平较低。为了解决这一差距，加拿大物质使用研究倡议召集了一个国家委员会，为高风险饮酒和酒精使用障碍的临床管理制定指南。
该指南的制定遵循 ADAPTE 流程，以 2019 年不列颠哥伦比亚省酒精使用障碍指南为基础。一个国家指南委员会（由 36 名成员组成，具有不同的专业知识，包括学者、临床医生、有过或正在经历酒精使用的人，以及自认为是土著或梅蒂斯人的人）选择了优先主题，审查了证据，并就建议达成了共识。我们使用评估研究和评估工具（AGREE II）和指南国际网络的利益披露和冲突管理原则，以确保指南符合透明度、高质量和方法严谨性的国际标准。我们使用推荐分级评估、制定与评价（GRADE）工具对最终建议进行评级；该建议由 13 名国内外专家和利益相关者进行了外部审查。
该指南包括 15 项建议，涵盖了筛查、诊断、戒断管理和持续治疗，包括心理社会治疗干预、药物治疗和基于社区的项目。指南委员会确定需要强调可能有益的未充分利用的干预措施，以及常见的不基于证据的处方和其他实践模式，这些模式可能会使酒精使用的结果恶化。
该指南旨在为医生、政策制定者和其他临床和非临床人员以及受酒精使用影响的个人、家庭和社区提供资源。该建议旨在为以循证方式解决加拿大大量未满足的酒精使用障碍治疗和护理需求提供一个框架。
