Pharmacotherapy for alcohol misuse: Views of patients, providers, and leaders in an Alaska Native healthcare system

Alcohol misuse is responsible for a significant public health burden in the United States and remains undertreated despite approved treatments for alcohol misuse such as naltrexone. The current study characterizes the views of stakeholders in an Alaska Native healthcare system regarding pharmacotherapy for alcohol misuse.

A secondary, mixed-methods analysis was conducted using qualitative data from 70 interview participants (patients, providers, and health system leaders) and survey data completed by 944 stakeholders (patients, providers, leadership, and administrative staff).

Five major themes were identified from the qualitative data: gaps in medication awareness and knowledge, perceived benefits of naltrexone, medication as a component of comprehensive treatment, concerns about pharmacotherapy for alcohol misuse, and the importance of shared decision-making. Survey results found that providers were significantly more likely than other stakeholders to favor the use of medications like naltrexone. Compared to non-AN/AI respondents, AN/AI individuals were less likely to believe that medication can help people achieve sobriety and were more likely to endorse survey statements that (1) strong people don't need medication and (2) people who use medication to support sobriety might be trading one addiction for another. Most respondents did not find medication assisted treatment to be against AN/AI cultural values, with no statistical difference between AN/AI and non-AN/AI survey respondents.

Identifying mismatches in stakeholders' attitudes and beliefs can highlight opportunities to increase uptake of effective therapies for alcohol misuse. Concerns about pharmacotherapy among patients as compared to providers and AN/AI individuals as compared to non-AN/AI suggests that under-prescribing may not be the main issue in lack of uptake of naltrexone. These findings suggest the importance of identifying patient beliefs about medication use as well as the need for wraparound services and supports for patients prescribed naltrexone.