title: Pharmacotherapy of alcohol use disorders by the Veterans Health Administration: patterns of receipt and persistence.
abstract: OBJECTIVE
  This study assessed changes since 2007 at Veterans Health Administration (VHA) facilities (N=129) in use of the medications approved by the U.S. Food and Drug Administration for treatment of alcohol use disorders.
  
  
  METHODS
  VHA data from fiscal years (FYs) 2008 and 2009 were used to identify patients with a diagnosis of an alcohol use disorder who received oral or extended-release naltrexone, disulfiram, or acamprosate as well as the proportion of days covered (PDC) in the 180 days after initiation and the time to first ten-day gap in possession (persistence) for each medication. Multilevel, mixed-effects logistic regression models examined the association between patient and facility characteristics and use of medications.
  
  
  RESULTS
  Nationally, 3.4% of VHA patients with an alcohol use disorder received medications in FY 2009 (11,165 of 331,635 patients), up from 3.0% in FY 2007. Use of medications by patients at the facilities ranged from 0% to 12%. In fully adjusted analyses, facilities offering evening and weekend services had higher rates of medication receipt, but other facility characteristics, such as having prescribers on the addiction program's staff or using medication to treat opioid or tobacco dependence, were unrelated to medication receipt. The mean PDC of acamprosate was significantly lower than mean PDCs of the other medications (p<.05), and persistence in use of naltrexone was significantly greater than use of acamprosate and significantly less than use of disulfiram (p<.05).
  
  
  CONCLUSIONS
  Use of these medications is increasing but remains variable across the VHA system. Interventions are needed to optimize initiation of and persistence in use of these medications.
authors.affiliation: Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025, USA. alexander.harris2@va.gov
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oliva
authors.forename: Thomas
authors.initials: T
authors.lastname: Bowe
authors.forename: Keith N
authors.initials: KN
authors.lastname: Humphreys
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
mesh_terms: D000328:Adult; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D058014:Veterans Health / Q000706:statistics & numerical data*
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists