Trends in the adoption of medications for alcohol dependence
Trends in the adoption of medications for alcohol dependence
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DOI：
10.1097/01.jcp.0000246209.18777.14
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发表时间：
2006-12-01
影响因子：
2.9
通讯作者：
Roman, Paul M.
中科院分区：
文献类型：
--
作者：
Ducharme, Lori J.;Knudsen, Hannah K.;Roman, Paul M.
人们越来越重视开发和传播治疗酒精和其他药物依赖的有效药物疗法。然而，许多结构和哲学障碍阻碍了这些治疗方法在日常临床实践中的广泛采用。需要研究来理解和克服这一差距。利用从两个大样本药物滥用治疗提供者在多个时间点收集的数据，本文审查了采用目前可用的酒精依赖药物疗法的流行率和相关性：双硫兰、口服纳曲酮和氨基己酸酯。这些数据表明，使用药物疗法治疗酒精依赖的治疗方案的比例随着时间的推移一直在下降。此外，给患者开这些药物的比例明显很低。在经过认证的项目中，采用双硫仑和纳曲酮的可能性明显更大，这些项目至少雇用一名医生，为患有共同精神疾病的患者提供综合护理，从商业保险支付者那里获得按比例更多的收入，以及与刑事司法系统的联系较少。初步数据表明，氨基己酸酯的早期采用也遵循类似的模式。对推广酒精依赖药物疗法提出了建议或解决了挑战。
Increasing attention is being paid to the development and dissemination of effective pharmacotherapies for the treatment of alcohol and other drug dependence. However, numerous structural and philosophical barriers impede the widespread adoption of these treatment approaches in everyday clinical practice. Research is needed to understand and overcome this gap. Drawing upon data collected from 2 large samples of substance abuse treatment providers at multiple time points, this article examines the prevalence and correlates of the adoption of the currently available pharmacotherapies for alcohol dependence: disulfiram, oral naltrexone, and acamprosate. These data suggest that the proportion of treatment programs using pharmacotherapies for alcohol dependence has been declining over time. In addition, the proportion of patients to whom these medications are prescribed is notably low. The adoption of disulfiram and naltrexone is significantly more likely in programs that are accredited, employ at least I physician, offer integrated care for patients with co-occurring psychiatric conditions, derive proportionately more revenue from commercial insurance payers, and have fewer linkages with the criminal justice system. Preliminary data suggest that the early adoption of acamprosate is following a similar pattern. Recommendations or addressing challenges to the diffusion of pharmacotherapies for alcohol dependence are presented.