Medications for Alcohol Use Disorder Are Rarely Used. Why?

Despite their availability and efficacy, medications for alcohol use disorder are rarely prescribed to adults with alcohol use disorder (AUD), a survey study found.

In an analysis of over 42,000 respondents to the 2019 National Survey on Drug Use and Health (NSDUH), 14.1 million adults, or 5.6%, reported AUD in the previous year, but only 1.6% (or 223,000 respondents) said they used medications for AUD, reported Beth Han, MD, PhD, MPH, of the National Institute on Drug Abuse in Bethesda, Maryland, and colleagues.

About 7% — or 1 million respondents — of those with past-year AUD described getting any alcohol use treatment, they noted in their JAMA Psychiatry research letter.

For the 7.9 million adults who identified as alcohol-dependent, just 2.7% said that they used medications for AUD. The 2019 NSDUH was the first national survey that included questions about whether respondents had used medications, such as acamprosate, disulfiram, or naltrexone, in their AUD treatment, the authors explained.

According to Henry Kranzler, MD, of the University of Pennsylvania, and an expert in pharmacological treatments of substance use disorders, the availability, safety, and success of medications for AUD are good reasons “for its widespread use in the care of patients with the disorder.”

“Further, naltrexone is a generic drug, so its cost is modest, which further supports its potential central role in the treatment of AUD,” he wrote in an email to MedPage Today.

Among the 42,739 survey respondents in this analysis, 53.4% were women.

Overall, Han and team found that adults who used medications for AUD were more likely to report more frequent emergency department (ED) visits and receiving mental health treatment, indicating that these medications may be associated with greater AUD severity.

They found that the use of medications for AUD, compared with no alcohol use treatment, was associated with living in metropolitan areas (adjusted OR 6.2, 95% CI 1.6-24.0), frequent visits to the ED (3 or more times in the past year; adjusted OR 6.6, 95% CI 1.7-25.5), alcohol dependence (adjusted OR 16.1, 95% CI 1.8-149.2), and receiving mental health care (adjusted OR 10.6, 95% CI 3.1-35.9).

When comparing use of medications with non-medication alcohol use treatment, use of medications was again associated with residing in large cities (adjusted OR 5.9, 95% CI 1.3-26.2), frequent ED visits (adjusted OR 8.9, 95% CI 2.0-38.6), and the receipt of mental health services (adjusted OR 4.3, 95% CI 1.2-15.8).

“Although guidelines suggest that patients with AUD should be prescribed [medications for AUD] and brief counseling as initial therapy or referred for more intensive psychosocial interventions … [these medications] are rarely prescribed to and used by adults with AUD,” the authors wrote.

There is still little known about the prevalence of use of medications for AUD in the U.S., they noted. However, the 2019 NSDUH provided a small window into what rates of medication use looked like pre-pandemic. In light of recent research that found that alcohol consumption has increased during the COVID-19 pandemic, experts have hypothesized that there’s a high likelihood that rates of AUD will also increase as a result. The rates of medication use may be drastically different now than they were in 2019 — but only time and further research will tell.

Han and colleagues acknowledged that the potential for recall and social desirability biases are limitations to their analysis; yet, these results “highlight the urgent need for improving access to and use of [medications] among adults with AUD,” they concluded.