Use of Medications for Alcohol Use Disorder in the US

Abstract

Treatment rates for alcohol use disorder (AUD) are low 1 (eg, 7.6% in 2019 2). The US Food and Drug Administration has approved 4 evidence-based medications for treating AUD (MAUD) since 1949. 3 To improve use of MAUD, the American Psychiatric Association released guidelines for pharmacological treatments of patients with AUD in 2017. 4 However, little is known about prevalence and associations of using MAUD among US adults with AUD. Methods | Data were from 42 739 adults 18 years and older who participated in the 2019 National Survey on Drug Use and Health (NSDUH), providing representative data among US civilian, noninstitutionalized populations, 2 including sociodemographic characteristics, past-year emergency department (ED) visits, illicit drug use, alcohol use, and receipt of mental health care and any alcohol use treatment (eg, at a specialty facility, ED, private physician's office, self-help group). Using DSM-IV diagnostic criteria, NSDUH assessed past-year illicit drug use disorder, AUD (DSM-IV dependence or abuse category), and major depressive episode. NSDUH data collection (through personal visits, using audio computer-assisted self-administered interviews) was approved by the institutional review board at RTI International. Respondents provided verbal informed consent. The 2019 NSDUH is the first nationally representative survey asking respondents with past-year receipt of alcohol use treatment to report whether they used medications (eg, acam-prosate, disulfiram, naltrexone oral/long-acting injectable formulations) prescribed by a physician or other health care professional to help reduce or stop alcohol use. The weighted response rate of the 2019 NSDUH was 45.8%. 2 We estimated prevalence of MAUD among US adults with AUD. Multivariable multinomial logistic regression modeling was applied to examine associations of using MAUD and differences between using MAUD and receiving non-MAUD alcohol use treatment. We used 2-sided t tests to calculate P values , and significance was set at a P value less than .05. SUDAAN software version 11.0.1 (RTI International) was used to conduct analyses, accounting for NSDUH's complex design and sampling weights. Results | Of 42 739 included adults, 22 807 (53.4%) were female. Among US adults in 2019, past-year prevalence of AUD was 5.6% (95% CI, 5.3-6.0), or 14.1 million persons (95% CI, 13.2-15.1). Among the 14.1 million adults with past-year AUD, 7.3% (95% CI, 5.8-8.8), or 1.0 million persons (95% CI, 0.8-1.2), reported receiving any alcohol use treatment in the past year, and 1.6% (95% CI, 0.9-2.3), or 223 000 persons (95% CI, 127 000-319 000), reported using MAUD. Among the 7.9 million adults with past-year alcohol dependence, 2.7% (95% CI, 1.6-3.8) reported using MAUD. Among adults with past-year AUD, compared with those with no alcohol use treatment, using MAUD was associated with residing in large metropolitan areas (adjusted odds ratio [AOR], 6.2; 95% CI, 1.6-24.0), frequent ED visits (3 or more times; AOR, 6.6; 95% CI, 1.7-25.5), alcohol dependence (AOR, 16.1; 95% CI, 1.8-149.2), and receiving mental health care (AOR, 10.6; 95% CI, 3.1-35.9) (Table). Compared with receiving non-medication alcohol use treatment, receiving MAUD was associated with residing in large metropolitan areas (AOR, 5.9; Table. Multivariable Multinomial Logistic Regression Results Among 3107 US Adults With Alcohol Use Disorder Characteristic AOR (95% CI) MAUD vs no alcohol use treatment Nonmedication alcohol use treatment vs no alcohol use treatment MAUD vs nonmedication alcohol use treatment Respondents, No. 2915 3069 230 Age, y 18-25 1 [Reference] 1 [Reference] 1 [Reference] 26-34 1.1 (0.2-5.4) 2.5 (1.3-5.0) a 0.4 (0.1-2.3) 35-49 1.1 (0.4-3.2) 1.9 (0.9-3.9) 0.6 (0.2-1.7) ≥50 1.1 (0.2-5.4) 1.6 (0.7-3.5) 0.7 (0.1-3.6) Sex Male 2.2 (0.8-5.9) 1.1 (0.7-1.7) 2.0 (0.7-5.9) Female 1 [Reference] 1 [Reference] 1 [Reference] Race/ethnicity b Non-Hispanic White 1 [Reference] 1 [Reference] 1 [Reference] Black 0.5 (0.1-2.6) 1.3 (0.6-2.6) 0.4 (0.1-2.9) Other 0.4 (0.1-1.9) 1.0 (0.5-2.2) 0.4 (0.1-1.8) Hispanic 1.0 (0.2-4.6) 1.1 (0.6-2.2) 0.8 (0.2-4.0) (continued) jamapsychiatry.com (Reprinted) JAMA Psychiatry Published online June 16, 2021 E1