FACTORS AFFECTING USE OF MEDICATION TO TREAT ALCOHOLISM

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In January 1995, naltrexone, marketed under the name REVIATM became the first medication approved by the Food and Drug Administration for alcoholism treatment in almost 50 years. The ifficacy of naltrexone, as an adjunct to therapy, in decreasing the mean number of drinking days per week, the frequency of relapse, and subjective craving for alcohol with few side effects has been shown in double blind randomized clinical trials. Despite the evidence of its efficacy, reports of its use indicate that it is not as widespread as might be expected. Total prescription of Revia in 1998 (including prescription for narcotic treatment) were 13,000 per month, only slightly more than the number of prescriptions in 1996. The 1992 National Longitudinal Alcohol Epidemiologic Survey estimated that 13.7 million adults met the criteria for alcohol abuse and alcohol dependence during the year preceding the interview (Grant, 1995). The one-day census of specialty substance abuse providers (NDATUS) indicates that in 1996, there were 677,000 clients in treatment for alcoholism. This figure excludes persons receiving treatment for alcoholism in institutions specializing in mental health care and in primary care settings. Thus, perhaps only 2 percent of persons receiving alcoholism treatment are being treated with naltrexone. Given the low utilization of naltrexone in the face of its apparent efficacy, it is critical to understand the barriers to the adoption of this important new pharmacological tool. The goal of this proposed research is to identify the factors that are influencing the use of naltrexone and to gain insight into its perceived efficacy among practitioners. Towards this end, the primarily aims of this study are: (1) to identify factors influencing use of naltrexone and their relative importance; (2) to determine whether other new medications to treat alcoholism are likely to face barriers to prescribing; (3) to identify methods that physicians used to overcome barriers to prescribing naltrexone; (4) to collect information on the types of patients being prescribed naltrexone and the circumstances under which it is being prescribed. We propose to collect this information through experts panels and a national survey of physicians specialized in treating substance abuse.