Physicians’ opinions about medications to treat alcoholism

Mark, Tami L.; Kranzler, Henry R.; Song, Xue; Bransberger, Peace; Poole, Virginia H.; Crosse, Scott

doi:10.1046/j.1360-0443.2003.00377.x

Cited by 104 publications

(107 citation statements)

References 29 publications

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“…These fi ndings show very clearly that having a physician on staff is not a suffi cient condition for adoption of medications. In fact, a 2003 study showed that only 9% of physicians working in the SUD treatment fi eld prescribed disulfi ram and 13% prescribed tablet naltrexone (Mark et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

Abraham¹,

Knudsen²,

Roman³

2011

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: The objectives of this study were to (a) identify the patterns of disulfi ram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfi ram and tablet naltrexone; and (c) measure reasons for medication discontinuation. Method: Two waves of data were collected via face-to-face structured interviews with 223 program administrators. Results: These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfi ram/tablet naltrexone with a newer AUD medication. Conclusions: These fi ndings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specifi c training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use. (J. Stud. Alcohol Drugs, 72, 669-677, 2011)

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Section: Discussionmentioning

confidence: 99%

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

Abraham¹,

Knudsen²,

Roman³

2011

J. Stud. Alcohol Drugs

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“…Although psychosocial interventions are the predominant mode of substance abuse treatment delivered in the US (Mark et al, 2003b), much effort has been directed toward the development of effective pharmacotherapies (McLellan and McKay, 1998). Agonist medications, such as methadone and buprenorphine, are a key group of pharmacotherapies for individuals who are dependent on opiates.…”

Section: Introductionmentioning

confidence: 99%

“…The emergent literature on medication adoption has been limited to regional samples (Fuller et al, 2005), private sector facilities (Knudsen et al, 2005;Roman and Johnson, 2002), and the practices of individual physicians (Mark et al, 2003a;Mark et al, 2003b). Understanding the role of treatment organizations is critical because recent research has revealed that the organizational context dramatically affects the prescribing behaviors of physicians and the likelihood that counselors will encourage and/or support the use of medications by their clients (Thomas et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Knudsen

Ducharme

Roman

2007

Drug and Alcohol Dependence

124

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Despite growing interest in closing the "research to practice gap," there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of "technology clusters," where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and forprofit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts.

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“…Esta rigidez ideológica en los servicios de adicciones se nota especialmente en Estados Unidos. Tal vez las actitudes cambien, pero un reciente estudio demuestra que menos del 15% de los pacientes de los médicos que tratan adicciones recibieron fármacos como la naltrexona o el disulfiram para el alcoholismo 12 . Los únicos casos equivalentes en PF (al menos en Occidente) son el reducido número de servicios de índole religiosa que ofrecen sólo técnicas basadas en la identificación del «período seguro».…”

Section: Explainingunclassified

“…Such ideological inflexibility in addiction services is particularly evident in the US. Attitudes may be changing but a recent survey showed that fewer than 15% of the patients of addiction physicians received drugs such as naltrexone or disulfiram for alcoholism 12 . The only FP equivalents (at least in the West) are the small number of religiously-based services that offer only techniques based on identifying the 'safe period'.…”

Section: Consejo Y Otras Intervenciones Psicosocialesmentioning

confidence: 99%

Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía

Brewer¹

2008

Adicciones

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El tratamiento de las adicciones busca reducir el daño que la adicción causa a los individuos y a la sociedad. Sin embargo, muchos servicios, sobre todo en el sector privado, tienen objeciones ideológicas a la hora de utilizar tratamientos médico-farmacológicos y se muestran críticos con otros servicios que sí ofrecen tratamientos farmacológicos. Esta situación contrasta profundamente con la actitud de las clínicas de planificación familiar (PF), que también buscan reducir daños. Irónicamente, las clínicas más antifarmacológicas suelen ser las que proclaman a toda voz que la adicción es una «enfermedad», mientras que el evitar un embarazo no deseado, que no se considera enfermedad, se aborda y soluciona de forma muy efectiva con técnicas médicas. Las clínicas de PF tienen en cuenta los diferentes modelos de conducta sexual, los contextos sociales y las actitudes de las pacientes cuando diseñan planes de tratamiento individuales, mientras que las clínicas que tratan adicciones parten de un enfoque de talla única o de «lo tomas o lo dejas». Los servicios de adicción pueden aprender lecciones clínicas e ideológicas muy útiles de las clínicas de PF.Palabras clave : adicción, alcohol, contracepción, reducción del daño, heroína, embarazo, naltrexona. Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía ABSTRACTAddiction treatment aims to reduce the harm that addiction causes to individuals and society. However, many clinics, especially in the private sector, have ideological objections to using medico-pharmacological treatments and are often critical of other services that do offer pharmacological treatments. This situation contrasts sharply with the attitude of family planning (FP) clinics, even though they too aim to reduce harm. Ironically, the most anti-pharmacological clinics are often those which proclaim most loudly that addiction is a 'disease', while avoiding unwanted pregnancy, which is not usually seen as a disease, is widely and effectively achieved with medical techniques. FP clinics typically consider widely varying patterns of sexual behaviour, social contexts and patient attitudes in devising individual treatment plans, while addiction clinics commonly have a one-size-fits-all, take-it-orleave-it approach. Addiction services could learn some useful clinical and ideological lessons from FP clinics.

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Physicians’ opinions about medications to treat alcoholism

Abstract: Physicians' low rate of use of naltrexone may reflect its small-to-medium effect size.

Cited by 104 publications

References 29 publications

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía

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