Pharmacotherapy of alcohol use disorders in the Veterans Health Administration.
OBJECTIVE
Acamprosate, oral and long-acting injectable naltrexone, and disulfiram are approved for treatment of alcohol dependence. Their availability and consideration of their use in treatment are now standards of high-quality care. This study determined rates of medication initiation among Veterans Health Administration (VHA) patients.


METHODS
VHA pharmacy and administrative data were used to identify patients with alcohol use disorder diagnoses in fiscal years (FY) 2006 and 2007 and the proportion (nationally and by facility) who received each medication. Patient characteristics associated with receipt were also examined.


RESULTS
Among more than a quarter-million patients with alcohol use disorder diagnoses, the percentage receiving any of the medications increased from 2.8% in FY 2006 to 3.0% in FY 2007. Receipt of these medications was more likely among patients who received specialty addiction care, those with alcohol dependence (compared with abuse), those younger than 55 years, and females. In the patient subgroups examined, the largest proportion to receive any of the medications was 11.6%. Across 128 VHA facilities, rates of use among patients in the sample who had received past-year specialty addiction treatment ranged from 0% to 20.5%; rates ranged from 0% to 4.3% among those with no specialty treatment. Patient preferences and medical contraindications could not be determined from the data.


CONCLUSIONS
Findings suggest the need to better understand systemwide variation in use of these medications and their use as a rough proxy for availability and consideration of pharmacotherapy--a standard of care with strong organizational support.
Harris
Alex H S
AH
Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Rd. (MC152), Menlo Park, CA 94025, USA. alexander.harris2@va.gov
Kivlahan
Daniel R
DR
Bowe
Thomas
T
Humphreys
Keith N
KN
D000077443:Acamprosate; D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation*; D000553:Ambulatory Care; D015897:Comorbidity; D003692:Delayed-Action Preparations; D004221:Disulfiram / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012737:Sex Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
D000077443:Acamprosate; D000427:Alcohol Deterrents; D003692:Delayed-Action Preparations; D004221:Disulfiram; D009271:Naltrexone; D017367:Selective Serotonin Reuptake Inhibitors; D013654:Taurine