Study Suggests Pharmacotherapy May Be Underused for Veterans with Alcohol Addiction
- In FY06 and FY07, only about 3% of more than a quarter of a million VA patients with alcohol use disorders received treatment with one of four drugs specifically approved for treating alcohol dependence: acamprosate, oral naltrexone, injectable naltrexone, and disulfiram (acamprosate and long-acting injectable naltrexone have non-formulary VA status). [This apparent underutilization is not unique to VA, as utilization rates are within the range of rates reported in other settings.]
- Receipt of pharmacotherapy was more likely among Veterans receiving specialty addiction care, Veterans with alcohol dependence (vs. abuse), Veterans younger than 55 years old, and women.
- Across the 128 VA facilities in this study, the proportion of patients with alcohol use disorders and specialty addiction treatment contact who received pharmacotherapy ranged from 0% to 21%, and 0% to 4% for patients without specialty addiction treatment contact.
- SSRI antidepressants were used about five times as often as alcohol use disorder medications in Veterans with an alcohol use disorder but without a psychiatric indication for SSRIs.
A recent study of U.S. prescription data found that although overall sales of FDA-approved medications for the treatment of alcohol dependence have grown rapidly in recent years, only a small proportion of Americans with alcohol use disorders are treated with medication therapy (.07% overall and 6% of those seeking specialty treatment). Availability and consideration of such medications was recently mandated for all VA facilities. This study sought to determine the extent to which these medications are initiated in the treatment of Veterans with alcohol use disorders who receive care in the VA healthcare system – and to examine patient characteristics associated with receiving this pharmacotherapy. Using VA data, investigators identified nearly 300,000 Veterans with an alcohol use disorder diagnosis in FY06 and FY07, who were treated at one of 128 VA facilities, with and without contact with the specialty addiction treatment system. They then determined the proportion of patients that received any of four medications approved for alcohol dependence (listed in findings).
- Available data do not include patient preferences or medical contraindications.
- There were no available data on prescriptions written by VA clinicians that were either not filled or were filled elsewhere.
- In light of these data, which have been shared with the Office of Mental Health Services, investigators are currently analyzing FY09 data; they also are initiating a research program to identify facility-level predictors of pharmacotherapy for alcohol use disorders.
This study was partly funded by HSR&D. Drs. Harris, Bowe, and Humphreys are part of HSR&D’s Center for Health Care Evaluation in Palo Alto, CA.
Harris A, Kivlahan D, Bowe T, and Humphreys K. Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration. Psychiatric Services April 2010;61(4):392-398.