Acceptability of pharmacotherapy for hazardous alcohol use among men who have sex with men: Findings from a qualitative study

Abstract

IntroductionMen who have sex with men (MSM) experience high rates of binge drinking, alcohol use disorder (AUD), and alcohol-related health issues. Pharmacotherapy for AUD can reduce hazardous drinking, yet remains underutilized among MSM. This qualitative study examined knowledge and perceptions regarding AUD medications among MSM, with an emphasis on naltrexone.MethodsThree focus group discussions (FGDs) with MSM who consumed alcohol in the past year were conducted in February 2015 (N = 39) in the San Francisco Bay Area. The FGD guide generated discussions about hazardous drinking, the social contexts of drinking, and alcohol reduction and cessation options, including pharmacotherapy. Interviews were analyzed via directed content analysis to codify themes.ResultsFor participants, drinking at LGBTQ bars was an important social activity. Many expressed interest in reducing alcohol use, but few had heard of pharmacotherapy for AUD. Potential uptake was limited by perceptions of disulfiram as the prototype medication, side effects associated with disulfiram, and concerns that medications do not address alcohol-related stigma or social drivers of drinking. Participants were more receptive to pharmacotherapy when presented with medication options that did not require abstinence. Participants reported being more likely to try pharmacotherapy as part of a peer group or treatment program.ConclusionsEfforts to increase the knowledge and availability of naltrexone and harm reduction approaches, while addressing addiction- and medication-related stigma, might improve pharmacotherapy uptake for AUD and decrease hazardous drinking among MSM for whom alcohol holds social significance.

Considerations and recommendations for mHealth interventions for substance use among Sexual and Gender Minority (SGM) individuals: A narrative review of the past 5 years

“…In particular, among GBMSM who engage in chemsex, lack of a safe and nonjudgmental environment to openly discuss their substance use and/or chemsex [ 40 ] was also mentioned as a system-level barrier, given limited laws and policies to support the rehabilitation of these individuals [ 23 ••, 28 ]. At the individual-level, seven studies (28%) noted shame and stigma associated with drug use [ 28 ] and SGM status [ 41 ] such as fear of disclosing their sexual practices [ 40 , 42 ] in particular among GBMSM who engage in chemsex, low self-efficacy for abstinence [ 37 ], and pharmacotherapy for substance use perceived as a replacement of one substance for another [ 34 , 43 ]. Two studies (8%) noted limited knowledge about available treatment options with a harm reduction approach [ 43 ] and pharmacological treatment [ 34 , 43 ], and concerns about the pharmacotherapy (e.g., side effects, [ 34 ]).…”

“…At the individual-level, seven studies (28%) noted shame and stigma associated with drug use [ 28 ] and SGM status [ 41 ] such as fear of disclosing their sexual practices [ 40 , 42 ] in particular among GBMSM who engage in chemsex, low self-efficacy for abstinence [ 37 ], and pharmacotherapy for substance use perceived as a replacement of one substance for another [ 34 , 43 ]. Two studies (8%) noted limited knowledge about available treatment options with a harm reduction approach [ 43 ] and pharmacological treatment [ 34 , 43 ], and concerns about the pharmacotherapy (e.g., side effects, [ 34 ]). Other barriers identified by a few studies included the social norms surrounding the use of certain substances [ 23 ••, 35 , 37 ], fear of losing perceived gains from substance use (e.g., self-confidence) [ 30 ], and beliefs that one should be motivated to be treated [ 34 ].…”

“…Unmet needs in current substance use treatment for SGM were assessed in some studies. One prominent theme was provision of psychoeducation on harm reduction, short/long-term negative consequences of substance use, and coping strategies, which emerged in 6 studies (24%) [ 28 , 34 , 36 , 37 , 40 , 43 ]. GBMSM were interested in learning how to use drugs safely as an alternative to complete abstinence [ 34 , 43 ].…”

“…One prominent theme was provision of psychoeducation on harm reduction, short/long-term negative consequences of substance use, and coping strategies, which emerged in 6 studies (24%) [ 28 , 34 , 36 , 37 , 40 , 43 ]. GBMSM were interested in learning how to use drugs safely as an alternative to complete abstinence [ 34 , 43 ]. Participants suggested providing psychoeducation on various options of substance use treatment (e.g., harm reduction, pharmacotherapy) [ 37 , 43 ] and potential drug interactions for transgender individuals receiving hormone therapy [ 43 ] as well as reliable harm reduction guidelines (e.g., dosing, safe chemsex, what to do in emergency, [ 40 ]).…”

“…GBMSM were interested in learning how to use drugs safely as an alternative to complete abstinence [ 34 , 43 ]. Participants suggested providing psychoeducation on various options of substance use treatment (e.g., harm reduction, pharmacotherapy) [ 37 , 43 ] and potential drug interactions for transgender individuals receiving hormone therapy [ 43 ] as well as reliable harm reduction guidelines (e.g., dosing, safe chemsex, what to do in emergency, [ 40 ]). Providing psychoeducation to teach coping skills [ 36 , 37 ] and to promote awareness of the negative consequences of substance use was also recommended (e.g., cost or changes in health associated with continuous substance use [ 36 , 37 ]) by using places where SGM individuals socialize (e.g., social media, bars, [ 28 ]).…”