Changing the Focus: Envisioning Alcohol Use Through a Harm Reduction Lens

Alcohol-related deaths are the third most preventable cause of death in the United States. In the last two decades, alcohol-related ED visits, hospitalizations, and deaths have increased significantly, particularly amongst women. According to the CDC, there are 261 deaths in the US related to alcohol every day, with alcohol-related harms and deaths on the rise amidst the COVID-19 pandemic. Preliminary data indicates that nearly 4.6 million more people were exceeding drinking guidelines from February to November 2020. Predating the COVID-19 pandemic, alcohol-related liver disease led to one third of alcohol-related deaths. Additional negative health consequences linked to alcohol include cancer, cardiac disease, digestive diseases, motor vehicle accidents, suicide, drowning, falls, and unsafe sexual practices. Despite this shocking toll, sparse attention is given by the medical field to implementing harm reduction approaches that may prevent negative consequences related to alcohol use. This is at odds with the opioid overdose epidemic, where many providers of medications for opioid use disorder are increasingly and successfully integrating harm reduction strategies into clinical practices. While there are three FDA-approved medications for alcohol use disorder, less than two percent of persons with alcohol use disorder report use of these medications; we believe in part this is related to an overreliance on abstinence as the primary endpoint warranting treatment. This session will focus on practical harm reduction strategies to engage persons who are using alcohol. These strategies can be implemented across disciplines and within a variety of settings. Examples of topics that will be discussed include: injury prevention strategies, addressing alcohol-associated gastrointestinal tract inflammation and nutrition, peer support models that seek to reduce risk rather than mandate abstinence, and moderated alcohol consumption. We will also address the underutilization of FDA-approved medications for alcohol use disorder, particularly in persons whose goal may not be abstinence. Session participants will gain practical skills through small group case-based discussions that will demonstrate the feasibility of implementing these strategies in clinical settings.