Comparative utilization of pharmacotherapy for alcohol use disorder and other psychiatric disorders among U.S. Veterans Health Administration patients with dual diagnoses.
Patients with alcohol use disorder (AUD) and another co-occurring psychiatric disorder are a vulnerable population with high symptom severity. Such patients may benefit from a full arsenal of treatment options including pharmacotherapy. Receipt of AUD pharmacotherapy is generally very low despite recommendations that it be made available to every patient with AUD, including those with co-occurring disorders. Little is known about pharmacotherapy rates for AUD compared to other psychiatric disorders among patients with dual diagnoses. This study compared rates of pharmacotherapy for AUD to those for non-substance use psychiatric disorders and tobacco use disorder among patients with dual diagnoses in the U.S. Veterans Affairs (VA) healthcare system. VA data were used to identify patients with AUD and another psychiatric disorder in fiscal year 2012, and to estimate the proportion receiving pharmacotherapy for AUD and for each comorbid condition. Among subsets of patients with AUD and co-occurring schizophrenic, bipolar, posttraumatic stress or major depressive disorder, receipt of medications for AUD ranged from 7% to 11%, whereas receipt of medications for the comorbid disorder ranged from 69% to 82%. Among patients with AUD and co-occurring tobacco use disorder, 6% received medication for their AUD and 34% for their tobacco use disorder. Among patients with dual diagnoses, rates of pharmacotherapy for AUD were far lower than those for the comorbid disorders and contrary to evidence that medications for AUD are effective. Additional system-wide implementation efforts to identify and address patient- and provider-level barriers are needed to increase AUD pharmacotherapy in this high-need population.
Veterans Affairs (VA) Substance Use Disorder Quality Enhancement Research Initiative (SUD QUERI), VA Palo Alto Health Care System, 795 Willow Road (MPD 152), Menlo Park, CA 94025, USA; Center for Innovation to Implementation (Ci2i), Health Services Research and Development, VA Palo Alto Health Care System, 795 Willow Road (MPD 152), Menlo Park, CA 94025, USA. Electronic address: Anna.Rubinsky@va.gov.
Anna D
AD
Rubinsky
Center for Innovation to Implementation (Ci2i), Health Services Research and Development, VA Palo Alto Health Care System, 795 Willow Road (MPD 152), Menlo Park, CA 94025, USA.
Cheng
C
Chen
Addiction Psychiatry Research Program, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA.
Steven L
SL
Batki
Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development (S-152), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Health Services, University of Washington, Box 357660, Seattle, WA 98195, USA.
Emily C
EC
Williams
Veterans Affairs (VA) Substance Use Disorder Quality Enhancement Research Initiative (SUD QUERI), VA Palo Alto Health Care System, 795 Willow Road (MPD 152), Menlo Park, CA 94025, USA; Center for Innovation to Implementation (Ci2i), Health Services Research and Development, VA Palo Alto Health Care System, 795 Willow Road (MPD 152), Menlo Park, CA 94025, USA.
Alex H S
AH
Harris
D000368:Aged; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008875:Middle Aged; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data; D058014:Veterans Health / Q000706:statistics & numerical data
Alcohol use disorder; Dual diagnosis; Medication; Pharmacotherapy; Psychiatric disorders