Understanding Indian Doctors' Attitudes Toward Alcohol Pharmacotherapy and Prescription: A Mediational Analysis

Alcohol use disorder (AUD) causes significant morbidity and mortality. Prescription of AUD pharmacotherapies remains low. Attitudes toward AUD pharmacotherapies influence their prescription rates. We conducted an online survey to assess how attitudes modulate the association between knowledge and prescription rates for four commonly used AUD medications among Indian clinicians.

An online survey was sent nationwide to Indian physicians between February and April 2023 to assess knowledge, attitudes, and practices of various AUD medications. An a priori model was defined to indicate the relationship between study variables. Bootstrapped correlation analysis was conducted to determine confidence intervals of the correlation coefficients between knowledge, attitudes, and prescription practices. Additional subgroup analysis was conducted for faculty and private psychiatrists to assess if they prescribed differently.

A total of 387 physicians responded to the survey. Bootstrapped correlation analysis indicated that safety and acceptability played a moderated prescription rates for acamprosate and naltrexone while they mediating role among faculty. For Disulfiram, perceived efficacy had a mediating effect, especially among private psychiatrists. Among faculty, perceived safety negatively mediated Disulfiram prescriptions. There was no indirect effect of attitudes on the association between knowledge and prescription practices for Baclofen.

The role of attitudes varied across medications. For acamprosate and naltrexone, perceived safety and acceptability significantly moderated prescription rates. For Disulfiram, perceived efficacy played a significant mediating effect. Attitudes did not influence Baclofen prescriptions as a whole, but acceptability significantly mediated prescriptions for private psychiatrists. This might indicate that physicians prescribe Baclofen as an ineluctable option.