title: A longitudinal examination of alcohol pharmacotherapy adoption in substance use disorder treatment programs: patterns of sustainability and discontinuation.
abstract: OBJECTIVE
  The objectives of this study were to (a) identify the patterns of disulfiram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfiram and tablet naltrexone; and (c) measure reasons for medication discontinuation.
  
  
  METHODS
  Two waves of data were collected via face-to-face structured interviews with 223 program administrators.
  
  
  RESULTS
  These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfiram/tablet naltrexone with a newer AUD medication.
  
  
  CONCLUSIONS
  These findings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specific training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use.
authors.affiliation: Institute for Behavioral Research, University of Georgia, Athens, 30602-2401, USA. aabraham@uga.edu
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Abraham
authors.forename: Hannah K
authors.initials: HK
authors.lastname: Knudsen
authors.forename: Paul M
authors.initials: PM
authors.lastname: Roman
mesh_terms: D000427:Alcohol Deterrents / Q000627:therapeutic use*; D019973:Alcohol-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D000437:Alcoholism / Q000188:drug therapy* / Q000534:rehabilitation; D016208:Databases, Factual; D004221:Disulfiram / Q000627:therapeutic use*; D004363:Drug Utilization / Q000639:trends*; D000431:Ethanol; D006801:Humans; D008137:Longitudinal Studies; D009271:Naltrexone / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration; D013997:Time Factors
chemical_list: D000427:Alcohol Deterrents; D000431:Ethanol; D009271:Naltrexone; D004221:Disulfiram