Medication-assisted treatment for alcohol use disorder
The Indiana Alcohol Research Center (ARC)’s Information Dissemination Core, led by David Crabb, MD, and Linda Chezem, is assessing the knowledge of primary care providers and judges about alcohol use disorders and the effectiveness of medication-assisted treatment (MAT). Although MAT for alcohol use disorder have existed for quite some time, they remain underutilized, especially in general medical settings. The Information Dissemination Core surveyed primary care and behavioral health specialists working in the Eskenazi Health system (the safety net hospital for Indianapolis, serving large numbers of patients with substance use disorders) in late 2019 and early 2020, as well as judges participating in four different national conferences during 2021.The respondents indicated that, while MAT was common for substance use disorder (91% used MAT for smoking cessation and 52% for opioid use disorders), only 52% had used MAT for alcohol use disorder. The providers were generally well-informed about naltrexone’s pharmacology, over half felt it was “important” or “very important” to offer MAT and 86% felt it was superior to counseling.
However, perceived barriers to use included lack of comfort in prescribing the drug, lack of other behavioral health services to offer with the MAT, uncertainty about the effectiveness of treatment in adolescents or those over 65 years of age, lack of time during primary care visits to discuss alcohol use disorder and its treatment, and (surprisingly) concern about liability. Eighty percent had been asked about MAT by patients at least once, but infrequently, suggesting lack of public awareness. Critically, interest in MAT seemed to track with readiness to reduce or stop drinking.
Since this survey effort, increased numbers of patients in the Eskenazi system are receiving prescriptions for MAT (see table) over the past 4 years. This includes prescriptions by primary care and behavioral health providers.
Medication |
2018 |
2019 |
2020 |
2021 |
Acamprosate |
17 |
18 |
22 |
107 |
Naltrexone HCl |
177 |
306 |
437 |
911 |
Naltrexone microspheres (Vivitrol) |
73 |
149 |
173 |
328 |
This effort suggests that raising awareness about treatment options for providers may have a significant impact on prescribing trends, especially among providers who are involved in the use of MAT for nicotine and opioid use disorders.