Barriers and Facilitators to Changing Drinking and Receiving Alcohol-Related Care: Interviews with Veterans Health Administration Primary Care Patients who Indicated Interest but Did Not Enroll in An Alcohol Care Management Intervention Trial

Abstract

Background: Most people with alcohol use disorder do not receive treatment, and primary care (PC)-based management of alcohol use disorder is a key strategy to close this gap. Understanding PC patients’ perspectives on changing drinking and receiving alcohol-related care is important for this goal, particularly among those who decline alcohol-related care. This study examined perspectives on barriers and facilitators to changing drinking and receiving alcohol-related care among Veterans Health Administration (VA) PC patients who indicated interest but did not enroll in the Choosing Healthier drinking Options In primary CarE trial (CHOICE), which tested a PC-based alcohol care management intervention. Methods: VA PC patients with frequent heavy drinking who indicated interest in CHOICE but did not enroll were invited to participate. Twenty-seven patients completed in-person, semi-structured interviews. Interview transcripts were analyzed using iterative deductive and inductive content analysis. Results: Participants were mostly men (96%) and White (59%), and the mean age was 48. Seventy-four percent met criteria for alcohol use disorder, and the median number of past-week standard drinks was 41.5. Participants reported fewer alcohol-related problems, lower importance of/readiness to change drinking, and higher confidence in their ability to change than patients who enrolled in the CHOICE trial. Barriers fell into 5 domains: drinking fulfills need(s); reducing drinking or treatment is not needed; treatment is not effective/not acceptable; alcohol-related stigma; and practical barriers. Facilitators fell into 4 domains: reasons to change drinking; social support; treatment is acceptable/meets patients’ needs; and practical facilitators. Participants discussed how Veteran identity and military experiences impacted drinking and willingness to receive care, which amplified multiple barriers/facilitators. Conclusions: This study identified barriers and facilitators to changing drinking and receiving alcohol-related care among VA PC patients who indicated interest but did not enroll in an alcohol care management trial. Findings can inform patient-centered interventions and support clinicians in engaging patients in care.

Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden

“…Barriers on the patient level are low knowledge of AUD pharmacotherapies [ 48 ], and the perception that AUD treatment is not effective [ 49 ]. Studies specifically focusing on individuals with AUD and medical comorbidities, highlight barriers such as the desire to handle alcohol-related problems independently, reluctance to abstinence-only-treatments, a perceived lack of integration between addiction care and medical care, and fear of stigmatisation [ 50 , 51 ].…”

The impact of COVID‐19 on trends in alcohol use disorder treatment in Veterans Health Administration

“…The lack of supplanted AUD pharmacotherapy in the COVID‐19 period may be related to low utilization pre‐COVID‐19 [23, 40, 51], but may also represent an opportunity to enhance AUD treatment use given the ongoing pandemic and its impact on health‐care. Numerous barriers to AUD treatment exist, including stigma, lack of patient‐perceived treatment need, limited knowledge regarding AUD treatment by patients and clinicians and limited perceived effectiveness of AUD treatment, among others [52, 53], and the decrease in treatment rates indicate that many barriers were further exacerbated by the pandemic.…”

“…The lack of supplanted AUD pharmacotherapy in the COVID-19 period may be related to low utilization pre-COVID-19[23,40,51], but may also represent an opportunity to enhance AUD treatment use given the ongoing pandemic and its impact on health-care. Numerous barriers to AUD treatment exist, including stigma, lack of patient-perceived treatment need, limited knowledge regarding AUD treatment by patients and clinicians and limited perceived effectiveness of AUD treatment, among others[52,53], and the decrease in treatment rates indicate that many barriers were further exacerbated by the pandemic.Examining telehealth delivery of treatment for vulnerable patients, including those with AUD, is particularly important in the current context of the ongoing COVID-19 pandemic. Much chronic care management, including behavioral health, has shifted from in-person to telehealth care during COVID-19[12], and our study findings parallel broader changes reported during COVID-19[54].…”