Barriers to the Use of Medications to Treat Alcoholism

Abstract

In 1994, naltrexone became the first medication approved by the Food and Drug Administration as an adjunct in alcoholism treatment in almost fifty years. Despite evidence of its efficacy, use of naltrexone is not widespread. Patient and physician focus groups were used to identify reasons naltrexone has not been prescribed more widely. Barriers to its widespread use include a lack of awareness, a lack of evidence of efficacy in practice, side effects, time for patient management, a reluctance to take medications, medication addiction concerns, Alcoholics Anonymous (AA) philosophy, and price. The study indicates that medications to treat alcoholism must overcome numerous barriers before becoming widely accepted.

Preliminary evaluation of extended-release naltrexone in Michigan and Missouri drug courts

“…In spite of robust evidence of efficacy and preliminary evidence for a cost offset advantage, use of medication in the treatment of alcohol dependence and abuse remains quite low (Mark et al, 2003;Mark, Kassed, Vandivort-Warren, Levit, & Kranzler, 2009;Harris, Kivlahan, Bowe, & Humphreys, 2010). The small sample size in the current project, in spite of training and policy explicitly supporting use of these medications, reflects the challenge that adoption of a medication treatment approach continues to face.…”

Comparing alternative specifications of quality measures: Access to pharmacotherapy for alcohol use disorders

“…(Harris, Kivlahan, Bowe, & Humphreys, 2010;Mark, Kassed, Vandivort-Warren, Levit, & Kranzler, 2009). Many barriers to greater use have been documented, including incongruence with addiction treatment program philosophy, lack of information and low perceived efficacy among providers, concerns about side effects, lack of patient demand, formulary restrictions, and high copayments (Horgan, Reif, Hodgkin, Garnick, & Merrick, 2008;Mark et al, 2003).…”

Choosing the right medication for the treatment of alcoholism

“…Naltrexone is thought to reduce heavy drinking by blocking the "high" that many of those who suffer from an alcohol disorder experience when they consume alcohol [16]. Almost 30 randomized controlled trials have been published demonstrating naltrexone's safety in alcohol-dependent individuals and its efficacy in reducing heavy drinking and promoting abstinence (More on this topic can found in an unpublished report by Pettinati et al) Nonetheless, despite promising clinical trial results in naltrexone studies, the tablet form of naltrexone has not been widely prescribed [8]. One major factor that has significantly dampened enthusiasm for oral naltrexone is that it is difficult to predict which patients will have trouble taking this medication every day.…”

“…However, there is evidence that disulfiram can be effective when patients are highly motivated to stop all drinking, or when their pill-taking is supervised by a health care professional or a caring family member [7•,25]. Still, currently, fewer than 250,000 disulfiram prescriptions are written in a year's time [8].…”

“…When disulfiram is prescribed today, it is primarily done in a supervised setting in which daily pill-taking is observed by staff or a reliable family member [7•]. In addition, despite naltrexone's different mechanism of action from disulfiram and the fact that its efficacy is strongly supported in the literature, this medication also has not been embraced by the treatment community to date [8]. Some data that indicate that patient nonadherence to daily pill-taking decreases response rates have been generated [9,10], and this may be one of the reasons that clinicians have not found oral naltrexone to be particularly effective in the clinical populations.…”