Pharmacotherapy is underutilized
Despite an increase in the use of psychotropic medications for treating psychiatric illness, pharmacotherapy for AUD is underutilized: only 3% of patients have received an FDA-approved treatment.2,3 Nearly one-third of adults are affected by AUD during their lifetime, yet only 20% seek help.3 Management today remains limited to episodic, brief inpatient detoxification and psychosocial therapy.
Recovery rates are highest when addiction treatment that monitors abstinence is continuous; yet, for the most part, alcohol addiction is treated in discrete episodes upon relapse. Although MAT is recommended by experts for “moderate” and “severe” substance use disorders, practitioners, in general, have demonstrated considerable resistance to using this modality as part of routine practice.4,5 This is regrettable: Regardless of terminology used to describe their condition, these people suffer a potentially fatal disease characterized by high post-treatment recidivism.
Neuroscience supports the brain disease model of addiction, with neuroplasticity changes being made during phases of drug use. Medications are shown to assist in preventing relapse while the brain is healing and normal emotional and decision-making capacities are being restored.6
Why hesitate to use pharmacotherapeutics?
There are diverse pharmacotherapeutic options that can be pursued for treating AUD with minimal disruption to home and work life. Alarmingly, many trainees have never prescribed or even considered such medications. Despite modest effect sizes in randomized controlled trials, efficacy has been demonstrated in reducing relapse rates and overall severity of drinking days.4,5 So, from where does the ambivalence of patients and providers about using these treatments to achieve lasting recovery stem?
Starting MAT certainly requires both parties to be in agreement. A patient might decline medication because of a fear of dependence or because he overestimates his ability to achieve remission on his own. There also may be financial barriers in a current alcohol treatment system that is traditionally non-medically oriented. Prescribers also fail to offer medications because of:
- lack of familiarity with available agents
- absence of guidelines for use
- disbelief that the condition is treatable.
Given that treatment often is based on a 12-step approach, such as Alcoholics Anonymous (AA), providers might hesitate to prescribe medication for an illness that is thought to be managed through psychosocial interventions, such as group and motivational therapy.