Clinician Prescribing Practices Involving Medications for Alcohol Use Disorder

Despite the heavy toll of alcohol use disorder (AUD) in the U.S., efficacious medications for AUD (MAUD) are rarely used. Minimal research has explored clinician prescribing practices involving MAUD.

Using a large national database of electronic health records, this cross-sectional analysis, conducted in 2023-2024, identified clinicians with at least 1 prescription order for an FDA-approved MAUD (naltrexone, acamprosate, or disulfiram) for a patient with AUD during 2016-2021. Descriptive statistics captured clinician-level prescribing volume and type of medication prescribed. Logistic regression models estimated the association between clinician characteristics and number of MAUD patients and type of medications prescribed.

Among the 38,626 clinician-years identified in the EHR data (representing 19,840 unique clinicians), 59% prescribed MAUD to a single patient. Psychiatrists (AOR=4.4, 95% CI=3.8, 4.9) and advanced practice providers (AOR=1.8, 95% CI=1.6, 2.0) were significantly more likely than primary care physicians to prescribe MAUD to 4 or more patients. Clinicians in the top tertile in the percentage of patients with a substance use disorder diagnosis were also more likely to prescribe MAUD to more patients (AOR=8.1, 95% CI=7.1, 9.7). These same clinician characteristics were also associated with greater odds of prescribing more than 1 type of AUD medication.

Most clinicians prescribing MAUD in a year did so rarely. Policy and health system change is needed to improve clinicians' pharmacologic treatment of AUD, with a focus on primary care physicians, with whom individuals with AUD may have the most frequent contact.