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Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population
James R Walker1, Jeffrey E Korte2, Aimee L McRae-Clark3
1Carolina Center for Behavioral Health, Greer, South Carolina.
Journal of Studies on Alcohol and Drugs
|October 12, 2019
Summary
Medication adherence for alcohol use disorder is low overall. Disulfiram showed significantly lower adherence compared to oral and injectable naltrexone in a Veterans Affairs study.
Area of Science:
- Pharmacology
- Public Health
- Clinical Medicine
Background:
- Medications approved by the U.S. Food and Drug Administration (FDA) are available for treating alcohol use disorders (AUDs).
- Medication effectiveness is contingent upon patient adherence to prescribed treatment regimens.
- Understanding adherence differences across AUD medications is crucial for optimizing clinical outcomes and treatment selection.
Purpose of the Study:
- To identify and compare adherence rates among FDA-approved medications for alcohol use disorder.
- To determine if significant differences in medication adherence exist between commonly prescribed AUD treatments.
Main Methods:
- A retrospective chart review of Veterans Affairs (VA) patients in the VISN-7 region (South Carolina and Georgia) from 2010-2015.
- Adherence was calculated as the percentage of days medication was available over a 6-month period based on prescription fills.
- Statistical analyses included chi-square, t tests, and logistic/linear regression to compare adherence across disulfiram, acamprosate, oral naltrexone, and extended-release injectable naltrexone.
Main Results:
- Mean medication availability (adherence) was 41.3% for disulfiram, 44.7% for acamprosate, 49.8% for oral naltrexone, and 54.6% for extended-release injectable naltrexone.
- Significant differences in adherence were observed between disulfiram and oral naltrexone (p = .002), and disulfiram and extended-release injectable naltrexone (p = .004).
- Achieving 80% adherence was substantially lower for disulfiram (11.9%) compared to oral naltrexone (22.7%) and extended-release injectable naltrexone (24.4%).
Conclusions:
- Overall adherence to medication-assisted treatment for alcohol use disorder remains low across all evaluated FDA-approved medications.
- Disulfiram demonstrated significantly lower adherence rates compared to both oral naltrexone and extended-release injectable naltrexone.
- These findings highlight potential disparities in adherence that may influence treatment effectiveness for AUDs.
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