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Case Definition for Alcohol Dependence

Andrew Thompson, Darren M Ashcroft, Lynn Owens, Tjeerd P Van Staa, Munir Pirmohamed

Type
Lifestyle Risk Factor
ID
PH692
Version ID
1384
Data Sources
Valid event data range
01/01/1990 - 31/12/2013
Sex
Female, Male
Agreement Date
2017-03-20
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Aim:

To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care.

Design:

Open cohort study.

Setting:

General practices contributing data to the UK Clinical Practice Research Database.

Participants:

39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013.

Main outcome measure:

Use of pharmacotherapy (acamprosate, disulfiram, naltrexone, baclofen and topiramate) to promote abstinence from alcohol or reduce drinking to safe levels in the first 12 months after a recorded diagnosis of alcohol dependence.

Findings:

Only 4,677 (11.7%) of the cohort received relevant pharmacotherapy in the 12 months following diagnosis. Of the 35,303 that did not receive pharmacotherapy, 3,255 (9.2%) received psychosocial support. The remaining 32,048 (80.2%) did not receive either mode of treatment in the first 12 months. Factors that independently reduced the likelihood of receiving pharmacotherapy included: being male (Odds Ratio [OR] 0.74; 95% CI 0.69 to 0.78); older (65-74 years: OR 0.61; 95% CI 0.49 to 0.77); being from a practice based in the most deprived quintile (OR 0.58; 95% CI 0.53 to 0.64); and being located in Northern Ireland (OR 0.78; 95% CI 0.67 to 0.91). The median duration to initiation of pharmacotherapy was 0.80 months (95% CI 0.70 to 1.00) for acamprosate and 0.60 months (95% CI 0.43 to 0.73) for disulfiram. Persistence analysis for those receiving acamprosate and disulfiram revealed that many patients never received a repeat prescription; persistence at 6 months was 27.7% for acomprosate and 33.2% for disulfiram. The median duration of therapy was 2.10 months (95% CI 1.87 to 2.53) for acamprosate and 3.13 months (95% CI 2.77 to 3.36) for disulfiram.

Conclusion:

Drug therapy to promote abstinence in alcohol dependent patients was low, with the majority of patients receiving no therapy, either psychological or pharmacological. When drug therapy was prescribed, persistence was low with most patients receiving only one prescription. Our data show that treatment for alcohol dependence is haphazard, and there is an urgent need to explore strategies for improving clinical management of this patient group.

Publications

  • Andrew Thompson, Darren M Ashcroft, Lynn Owens, Tjeerd P Van Staa, Munir Pirmohamed, Drug therapy for alcohol dependence in primary care in the UK A Clinical Practice Research Datalink study. POLS ONE, 12(3), e0173272, 2017.

Clinical Code List

Rows: 39
Code Description Entity type Category Coding System (Read)
8BA8.00 alcohol detoxification res58: case definition for alcohol dependence diagnostic Read
8H35.00 admitted to alcohol detoxification centre res58: case definition for alcohol dependence diagnostic Read
E010.00 Alcohol withdrawal delirium res58: case definition for alcohol dependence diagnostic Read
E010.12 Delirium tremens res58: case definition for alcohol dependence diagnostic Read
E012000 Chronic alcoholic brain syndrome res58: case definition for alcohol dependence diagnostic Read
E013.00 Alcohol withdrawal hallucinosis res58: case definition for alcohol dependence diagnostic Read
E01y000 Alcohol withdrawal syndrome res58: case definition for alcohol dependence diagnostic Read
E23..00 Alcohol dependence syndrome res58: case definition for alcohol dependence diagnostic Read
E23..11 Alcoholism res58: case definition for alcohol dependence diagnostic Read
E230.00 Acute alcoholic intoxication in alcoholism res58: case definition for alcohol dependence diagnostic Read
E230.11 Alcohol dependence with acute alcoholic intoxication res58: case definition for alcohol dependence diagnostic Read
E230000 Acute alcoholic intoxication, unspecified, in alcoholism res58: case definition for alcohol dependence diagnostic Read
E230100 Continuous acute alcoholic intoxication in alcoholism res58: case definition for alcohol dependence diagnostic Read
E230300 Acute alcoholic intoxication in remission, in alcoholism res58: case definition for alcohol dependence diagnostic Read
E230z00 Acute alcoholic intoxication in alcoholism NOS res58: case definition for alcohol dependence diagnostic Read
E231.00 Chronic alcoholism res58: case definition for alcohol dependence diagnostic Read
E231.11 Dipsomania res58: case definition for alcohol dependence diagnostic Read
E231100 Continuous chronic alcoholism res58: case definition for alcohol dependence diagnostic Read
E231300 Chronic alcoholism in remission res58: case definition for alcohol dependence diagnostic Read
E231z00 Chronic alcoholism NOS res58: case definition for alcohol dependence diagnostic Read
E23z.00 Alcohol dependence syndrome NOS res58: case definition for alcohol dependence diagnostic Read
Eu10200 [X]Mental and behavioural disorders due to use of alcohol: dependence syndrome res58: case definition for alcohol dependence diagnostic Read
Eu10211 [X]Alcohol addiction res58: case definition for alcohol dependence diagnostic Read
Eu10212 [X]Chronic alcoholism res58: case definition for alcohol dependence diagnostic Read
Eu10213 [X]Dipsomania res58: case definition for alcohol dependence diagnostic Read
Eu10300 [X]Mental and behavioural disorders due to use of alcohol: withdrawal state res58: case definition for alcohol dependence diagnostic Read
Eu10400 [X]Mental and behavioural disorders due to use of alcohol: withdrawal state with delirium res58: case definition for alcohol dependence diagnostic Read
Eu10411 [X]Delirium tremens, alcohol induced res58: case definition for alcohol dependence diagnostic Read
Eu10712 [X]Chronic alcoholic brain syndrome res58: case definition for alcohol dependence diagnostic Read
Eu10800 [X]Alcohol withdrawal-induced seizure res58: case definition for alcohol dependence diagnostic Read
F11x000 Cerebral degeneration due to alcoholism res58: case definition for alcohol dependence diagnostic Read
F11x011 Alcoholic encephalopathy res58: case definition for alcohol dependence diagnostic Read
F375.00 Alcoholic polyneuropathy res58: case definition for alcohol dependence diagnostic Read
F394100 Alcoholic myopathy res58: case definition for alcohol dependence diagnostic Read
G555.00 Alcoholic cardiomyopathy res58: case definition for alcohol dependence diagnostic Read
J612.00 Alcoholic cirrhosis of liver res58: case definition for alcohol dependence diagnostic Read
J617000 Chronic alcoholic hepatitis res58: case definition for alcohol dependence diagnostic Read
J671000 Alcohol-induced chronic pancreatitis res58: case definition for alcohol dependence diagnostic Read
Z191.00 alcohol detoxification res58: case definition for alcohol dependence diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH692/version/1384/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH692/version/1384/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH692', '1384', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH692/version/1384/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH692/version/1384/export/codes/?format=json
CSV site_root/phenotypes/PH692/version/1384/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH692', '1384', api_client=client)

Version History

Version
ID
Name Owner Publish date
1384 Case Definition for Alcohol Dependence ieuan.scanlon 2021-10-06 currently shown

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