title: Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care.
abstract: BACKGROUND
  Alcohol dependence (AD) in Europe is prevalent and causes considerable health burden. Recognition by general practitioners (GPs) and provision of or referral to treatment may contribute to reduce this burden. This paper studied AD prevalence in varying European primary care settings and examined who received treatment.
  
  
  METHODS
  In a cross-sectional multi-centre study in six European countries, 358 general practitioners assessed 13,003 primary care patients between January 2013 and January 2014, of which 8,476 patients were interviewed, collecting information on socio-demographics, physical and mental problems, and on alcohol use, problems and treatment. AD diagnoses were determined by GPs' clinical judgement and a standardized interview. A wide definition for AD treatment included individual and group interventions provided by different health professionals. Descriptive as well as inferential statistics were employed.
  
  
  RESULTS
  AD was prevalent among patients in European primary health care settings (8.7 %, 95 % confidence interval (CI): 8.1-9.3 %). Treatment rates were low (22.3 % of all AD cases, 95 % CI: 19.4-25.2 %). For both prevalence and treatment utilization, considerable country variations were observed. AD was associated with a number of socio-economic disadvantages (e.g. higher unemployment rate) and higher physical (e.g., liver disease, hypertension) and mental comorbidities (e.g., depression, anxiety). Liver problems, mental distress and daily amount of alcohol used were higher among treated versus untreated male patients with AD.
  
  
  CONCLUSIONS
  A minority of people identified as having AD received treatment, showing heavier drinking patterns and a higher level of co-morbidity. Different types of treatment, depending on severity of AD, should be considered.
authors.affiliation: Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.|Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada. jtrehm@gmail.com.|Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada. jtrehm@gmail.com.|Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.|Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jtrehm@gmail.com.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Via Pietro Dazzi 1, 50141, Firenze, Italy. allamana@gmail.com.
authors.forename: Allaman
authors.initials: A
authors.lastname: Allamani
authors.affiliation: Corvinus University of Budapest, Közraktár u. 4-6, H-1093, Budapest, Hungary. elekesdr@gmail.com.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Elekes
authors.affiliation: Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. and344@wp.pl.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Jakubczyk
authors.affiliation: Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jakobmanthey@snappyquest.org.
authors.forename: Jakob
authors.initials: J
authors.lastname: Manthey
authors.affiliation: Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. charlotte.probst@tu-dresden.de.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Probst
authors.affiliation: Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. pstruzzo@gmail.com.|Department of Life Sciences, University of Trieste, Via Weiss, 2, 34128, Trieste, Italy. pstruzzo@gmail.com.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Struzzo
authors.affiliation: Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. roberto.dellavedova@tin.it.|Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052, Monza (MI), Italy. roberto.dellavedova@tin.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Della Vedova
authors.affiliation: Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.|Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036, Barcelona, Catalonia, Spain. TGUAL@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Gual
authors.affiliation: Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. marcin.wojnar@wum.edu.pl.|Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA. marcin.wojnar@wum.edu.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wojnar
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires