Barriers to the Use of Medications to Treat Alcoholism

Mark, Tami L.; Kranzler, Henry R.; Poole, Virginia H.; Hagen, Carol A.; McLeod, Caroline; Crosse, Scott

doi:10.1080/10550490390226879

Cited by 76 publications

(97 citation statements)

References 25 publications

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“…For some, medications are incompatible with the 12-steps' value system (Abraham et al, 2011), which emphasizes combinations of individual transformation and overall freedom from drugs as fundamental to successful recovery (Alcoholics Anonymous [AA], 1984). Several researchers found that 12-step groups have historically been seen as antithetical to the use of MAT (Mark et al, 2003;Swift et al, 1998), and members often experience pressure to stop taking medications (Rychtarik et al, 2000). Nevertheless, 12-step approaches do not necessarily preclude the use of any SUD medications, for other principles encourage those in recovery to follow physician recommendations, including being medically compliant (Alcoholics Anonymous, 1984).…”

Section: Barriers To the Adoption Of Injectable Naltrexonementioning

confidence: 99%

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

Aletraris

Edmond

Roman

2015

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration-approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption. Method: The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone. Results: Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxifi cation services. For-profi t status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors' reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a signifi cant issue for the majority of adopting organizations. Conclusions: The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time. (J. Stud. Alcohol Drugs, 76, 143-151, 2015)

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Section: Barriers To the Adoption Of Injectable Naltrexonementioning

confidence: 99%

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

Aletraris

Edmond

Roman

2015

J. Stud. Alcohol Drugs

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“…Organizations generally parallel the values of the dominant culture and the treatment field still adheres to traditional beliefs, ideologies, and philosophical practices that date back to the early 20th century (Ducharme et al, 2006;Roman et al, 2000;White, 1998). Specifically, there may be some resistance toward the use of pharmacotherapies among alcohol-dependent individuals (Rychtarik et al, 2000;Mark et al, 2003) and counselors (Knudsen et al, 2005) who adhere to a 12-step philosophy. However, it should be noted that self-help programs recommend that members follow their physician's medical advice and be medication compliant (Alcoholics Anonymous [AA], 1984).…”

mentioning

confidence: 99%

Organizational-Level Predictors of Adoption Across Time: Naltrexone in Private Substance-Use Disorders Treatment Centers

Oser

Roman

2007

J. Stud. Alcohol Drugs

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Objective-Prominent on the nation's research agenda on substance-use disorders treatment is the dissemination of effective pharmacotherapies. Thus, the purpose of this article is to use a "diffusion of innovations" theoretical framework to examine the organizational-level predictors of the adoption of a pharmacotherapy, naltrexone (Revia), in private substance use-disorders treatment centers (N = 165).Method-Data for these analyses were derived from the National Treatment Center Study, which contains four waves of data collected between 1994 and 2003. An event history model examined the impact of culture, leadership characteristics, internal structure, and external characteristics on the likelihood of adopting naltrexone between 1994 and 2003.Results-The results suggest that organizations embracing a 12-step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Moreover, treatment centers that used prescription drugs, possessed an employee handbook, were accredited, and operated on a for-profit basis were significantly more likely to adopt naltrexone over time.Conclusions-Structural characteristics do affect the innovation adoption behaviors of private substance-use disorders treatment centers. Organizational-level "research to practice" implications to further the adoption of innovative evidence-based treatments are discussed.A Major Focus Within the substance-use disorders treatment field is on conducting clinical trials in an effort to identify more effective treatment modalities. Despite the development of a number of evidence-based treatment strategies, including pharmacotherapies, substanceuse disorders treatment providers (Foreman et al., 2001;McGovern et al., 2004) and community treatment programs have been slow to adopt these new strategies Lamb et al., 1998;Read et al., 2001) suggesting that the adoption of innovations is a more complex organizational process. We argue that much of the "gap" that exists between research and practice can be explained by the structural variations of treatment organizations. Therefore, the purpose of this article is to use a "diffusion of innovations" * This research was supported by National Institute on Drug Abuse grants R01-DA13110 and R03-DA107199. (Rogers, 2003) to examine the organizational predictors of innovation adoption in private substance-use disorders treatment centers using an event history analysis. Specifically, the adoption of naltrexone (Revia) between 1994 and 2003 will be explored. Naltrexone is an opiate antagonist used in the treatment of both opiate and alcohol dependence. The development of naltrexone for the treatment of opiate dependence was approved by the U.S. Food and Drug Administration (FDA) in 1984. Subsequently, naltrexone can be defined as an innovation (Rogers, 2003) since it was approved for the treatment of alcohol dependence a decade later based on two randomized trials (O'Malley et al., 1992;Volpicelli et al., 1992). Theoretical concepts predicting naltrexone adoptionA...

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“…There have been three medications approved by the U.S. Food and Drug Administration: disulfiram (Antabuse), acamprosate (Campral), and naltrexone (ReVia, Vivitrol) -all of which suffer from limited effectiveness due to sideeffects and compliance issues (Bouza et al, 2004;Mark et al, 2003a;Mark et al, 2003b;Pettinati et al, 2000). The aldehyde dehydrogenase blocker, disulfiram has not been very effective for treating AUDs (Johnson, 2008;O'Shea, 2000) primarily because of patient compliance (Johnson, 2008;O'Shea, 2000).…”

Section: Current Therapeutics For the Treatment Of Alcohol Use Disordersmentioning

confidence: 99%

The Role of Delta Opioid Receptors in Ethanol Consumption and Seeking: Implications for New Treatments for Alcohol Use Disorders

Nielsen¹,

Bartlett²

2012

Neuroscience - Dealing With Frontiers

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Barriers to the Use of Medications to Treat Alcoholism

Cited by 76 publications

References 25 publications

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

Organizational-Level Predictors of Adoption Across Time: Naltrexone in Private Substance-Use Disorders Treatment Centers

The Role of Delta Opioid Receptors in Ethanol Consumption and Seeking: Implications for New Treatments for Alcohol Use Disorders

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