Low Demand for Treatment Is One of the Obstacles in Combating Alcohol Dependence, Study Finds

Despite the wide availability of evidence-based treatments for mental and substance use disorders, most affected individuals still do not receive adequate care. The situation is particularly critical in the case of Alcohol Use Disorder (AUD), a highly prevalent condition marked by low treatment-seeking behavior, poor-quality care, and significant stigma.

Low Coverage of Effective Treatment for Alcohol Dependence

Recent data from the World Mental Health Survey, published in JAMA Psychiatry, reveal that only 1.4% of people with Alcohol Use Disorder received effective treatment in accordance with clinical guidelines.¹ The study analyzed information from more than 56,000 adults in 21 countries, using representative population samples and standardized household interviews based on the Composite International Diagnostic Interview (CIDI).

The methodology considered three levels of assessment in the so-called “coverage cascade”: (1) perceived need for treatment, (2) contact with health services, and (3) receipt of effective treatment, defined according to criteria of frequency, duration, and adherence for both psychotherapy and pharmacotherapy. In the case of AUD, the data indicated that only about one-third of affected individuals perceived a need for help, and an even smaller fraction actually sought or received treatment of a quality consistent with international guidelines.¹

Inequality of Access and Underutilization of Services

Low perception of the need for treatment, combined with social stigma and insufficient training among many health professionals, contributes to the undertreatment of AUD. A review published in The Lancet Psychiatry in 2022 reinforces this scenario, noting that fewer than 10% of patients with AUD in Europe receive any type of specialized intervention, even when they have a prior history of contact with health services.²

Impact of Simple and Timely Interventions

Studies also suggest that even brief interventions carried out during hospitalizations for other causes can reduce mortality and readmissions among people with alcohol and other substance dependence. One study showed that this type of approach can generate clinically relevant benefits, even when the patient does not subsequently gain access to specialized services.³

Conclusion and Implications for Public Policy

Given the large treatment gap for alcohol and other substance dependence, an urgent response is needed that goes beyond simply expanding service availability. Primary care must be trained to identify and initiate treatment, ensure continuity of care, and address the stigma that still keeps many patients away from health services.

In many Brazilian cities, basic medications for the treatment of alcohol dependence are still lacking, which directly compromises the effectiveness of interventions. Public policies should focus not only on access, but also on treatment quality, ensuring professional training, regular availability of medications, and integration between mental health care and primary care.

References:

1. Vigo, D.V., Stein, D.J., Harris, M.G., et al. (2025). Effective Treatment for Mental and Substance Use Disorders in 21 Countries. JAMA Psychiatry, 82(4), 347–357. https://doi.org/10.1001/jamapsychiatry.2024.4378
2. Rehm, J., Manthey, J., Shield, K.D., Ferreira-Borges, C. (2022). Barriers to treatment for alcohol use disorders in Europe: a literature review. Lancet Psychiatry, 9(2), 89–100. https://doi.org/10.1016/S2215-0366(21)00485-6
   
3. Lee, M.T., Gordon, A.J., Williams, J.T., et al. (2023). Association of Brief Inpatient Alcohol Interventions With Mortality and Readmission Among Adults With Alcohol Use Disorder. JAMA Network Open, 6(5):e2311507. https://doi.org/10.1001/jamanetworkopen.2023.11507