Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study.
OBJECTIVE
To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care.


METHODS
Open cohort study.


METHODS
General practices contributing data to the UK Clinical Practice Research Database.


METHODS
39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013.


METHODS
Use of pharmacotherapy (acamprosate, disulfiram, naltrexone, baclofen and topiramate) to promote abstinence from alcohol or reduce drinking to safe levels in the first 12 months after a recorded diagnosis of alcohol dependence.


RESULTS
Only 4,677 (11.7%) of the cohort received relevant pharmacotherapy in the 12 months following diagnosis. Of the 35,303 that did not receive pharmacotherapy, 3,255 (9.2%) received psychosocial support. The remaining 32,048 (80.2%) did not receive either mode of treatment in the first 12 months. Factors that independently reduced the likelihood of receiving pharmacotherapy included: being male (Odds Ratio [OR] 0.74; 95% CI 0.69 to 0.78); older (65-74 years: OR 0.61; 95% CI 0.49 to 0.77); being from a practice based in the most deprived quintile (OR 0.58; 95% CI 0.53 to 0.64); and being located in Northern Ireland (OR 0.78; 95% CI 0.67 to 0.91). The median duration to initiation of pharmacotherapy was 0.80 months (95% CI 0.70 to 1.00) for acamprosate and 0.60 months (95% CI 0.43 to 0.73) for disulfiram. Persistence analysis for those receiving acamprosate and disulfiram revealed that many patients never received a repeat prescription; persistence at 6 months was 27.7% for acomprosate and 33.2% for disulfiram. The median duration of therapy was 2.10 months (95% CI 1.87 to 2.53) for acamprosate and 3.13 months (95% CI 2.77 to 3.36) for disulfiram.


CONCLUSIONS
Drug therapy to promote abstinence in alcohol dependent patients was low, with the majority of patients receiving no therapy, either psychological or pharmacological. When drug therapy was prescribed, persistence was low with most patients receiving only one prescription. Our data show that treatment for alcohol dependence is haphazard, and there is an urgent need to explore strategies for improving clinical management of this patient group.
Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
Andrew
http://orcid.org/0000-0002-7087-9415
A
Thompson
Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom.
Darren M
DM
Ashcroft
Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.|Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, Prescot Street, Liverpool, United Kingdom.
Lynn
L
Owens
Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom.|Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
Tjeerd P
TP
van Staa
Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
Munir
M
Pirmohamed
D000077443:Acamprosate; D000293:Adolescent; D000328:Adult; D000368:Aged; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D004221:Disulfiram / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D000427:Alcohol Deterrents; D013654:Taurine; D000077443:Acamprosate; D004221:Disulfiram