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Published Online: 1 July 2012

Pharmacotherapy of Alcohol Use Disorders by the Veterans Health Administration: Patterns of Receipt and Persistence

Abstract

Objective:

This study assessed changes since 2007 at Veterans Health Administration (VHA) facilities (N=129) in use of the medications approved by the U.S. Food and Drug Administration for treatment of alcohol use disorders.

Methods:

VHA data from fiscal years (FYs) 2008 and 2009 were used to identify patients with a diagnosis of an alcohol use disorder who received oral or extended-release naltrexone, disulfiram, or acamprosate as well as the proportion of days covered (PDC) in the 180 days after initiation and the time to first ten-day gap in possession (persistence) for each medication. Multilevel, mixed-effects logistic regression models examined the association between patient and facility characteristics and use of medications.

Results:

Nationally, 3.4% of VHA patients with an alcohol use disorder received medications in FY 2009 (11,165 of 331,635 patients), up from 3.0% in FY 2007. Use of medications by patients at the facilities ranged from 0% to 12%. In fully adjusted analyses, facilities offering evening and weekend services had higher rates of medication receipt, but other facility characteristics, such as having prescribers on the addiction program's staff or using medication to treat opioid or tobacco dependence, were unrelated to medication receipt. The mean PDC of acamprosate was significantly lower than mean PDCs of the other medications (p<.05), and persistence in use of naltrexone was significantly greater than use of acamprosate and significantly less than use of disulfiram (p<.05).

Conclusions:

Use of these medications is increasing but remains variable across the VHA system. Interventions are needed to optimize initiation of and persistence in use of these medications. (Psychiatric Services 63:679–685, 2012; doi: 10.1176/appi.ps.201000553)

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Figures and Tables

Table 1 Medication treatment of patients with an alcohol use disorder by the Veterans Health Administration, by fiscal year
Table 2 Patient and facility factors predicting receipt of medication approved by the U.S. Food and Drug Administration for treatment of alcohol dependence
Table 3 Proportion of days covered (PDC) among 10,779 patients receiving medication for treatment of an alcohol use disorder, by days' supply
Table 4 Patient and facility factors predicting proportion of days covered among medications approved by the U.S. Food and Drug Administration for treatment of alcohol dependence
Table 5 Time to first gap of ten days or more in possession of medication to treat alcohol dependence among Veterans Health Administration patients, fiscal years 2008 and 2009

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Cover: Flag on Orange Field, by Jasper Johns, 1967. Museum Ludwig, Cologne, Germany. © VAGA, New York. Photo © Erich Lessing/Art Resource, New York.
Psychiatric Services
Pages: 679 - 685
PubMed: 22549276

History

Published online: 1 July 2012
Published in print: July 2012

Authors

Details

Alex H. S. Harris, Ph.D., M.S.
With the exception of Dr. Kivlahan, the authors are affiliated with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025 (e-mail: [email protected]). Dr. Kivlahan is with the VA Puget Sound Health Care System and the University of Washington School of Medicine, Seattle.
Elizabeth Oliva, Ph.D.
With the exception of Dr. Kivlahan, the authors are affiliated with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025 (e-mail: [email protected]). Dr. Kivlahan is with the VA Puget Sound Health Care System and the University of Washington School of Medicine, Seattle.
Thomas Bowe, Ph.D.
With the exception of Dr. Kivlahan, the authors are affiliated with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025 (e-mail: [email protected]). Dr. Kivlahan is with the VA Puget Sound Health Care System and the University of Washington School of Medicine, Seattle.
Keith N. Humphreys, Ph.D.
With the exception of Dr. Kivlahan, the authors are affiliated with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025 (e-mail: [email protected]). Dr. Kivlahan is with the VA Puget Sound Health Care System and the University of Washington School of Medicine, Seattle.
Daniel R. Kivlahan, Ph.D.
With the exception of Dr. Kivlahan, the authors are affiliated with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025 (e-mail: [email protected]). Dr. Kivlahan is with the VA Puget Sound Health Care System and the University of Washington School of Medicine, Seattle.
Jodie A. Trafton, Ph.D.
With the exception of Dr. Kivlahan, the authors are affiliated with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Rd., 152-MPD, Menlo Park, CA 94025 (e-mail: [email protected]). Dr. Kivlahan is with the VA Puget Sound Health Care System and the University of Washington School of Medicine, Seattle.

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