Discontinuation of medications for alcohol use disorder in the United States: Patient, prescriber and medication predictors

IF 5.9 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2026-09-15 Epub Date: 2026-06-09 DOI:10.1111/add.70498

Alisa B. Busch, Dominic Hodgkin, Alene Kennedy-Hendricks, Grant A. Ritter, Lori Uscher-Pines, Constance M. Horgan, Haiden A. Huskamp

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Abstract

Background and aims

Little is known about medication for alcohol use disorder (MAUD) adherence. The goal of this study was to examine patient, prescriber and medication characteristics associated with time to discontinuation of MAUD.

Design, setting and participants

Observational cohort study from Optum Labs de-identified administrative claims data of a United States national sample of commercial and Medicare Advantage enrollees with alcohol use disorder (AUD) who initiated MAUD (naltrexone, acamprosate, disulfiram, topiramate) January 2017–June 2024 (n = 51 915). Using an accelerated failure time (AFT) log logistic survival model, we examined MAUD discontinuation, adjusting for patient demographic and clinical characteristics established within 6 months prior to or on date of initiation, specific MAUD initiated with, MAUD prescriber type and study year. We defined effect size of at least 10% change in AFT survival (i.e. AFT estimates > +/− 0.100) as being of clinical significance.

Measurements

Time-to-discontinuation of MAUD, defined as a gap in pharmacy fills or medication administrations of MAUD days-supply >7 days.

Findings

In unadjusted analyses, the median time to MAUD discontinuation was 30 days; median days-supply prior to discontinuation varied by medication (e.g. 30 days for acamprosate and naltrexone, 56 for disulfiram, 60 for topiramate). Adjusted analyses showed that among the patient characteristics, longer MAUD duration was associated with older age [e.g. AFT duration estimate (95% confidence interval) for age ≥65 vs. 18–30 = 0.164 (0.088–0.240)], while lower county median household income was associated with shorter duration [e.g. <$40 000 vs. ≥$200 000: −0.106 (−0.136 to −0.076)]. MAUD initiations via topiramate (vs. naltrexone) were associated with longer duration [0.339 (0.311–0.366)], as were initiations via disulfiram [0.103 (0.076–0.131)]. MAUD duration increased in recent study years, except 2024 [(e.g. 2023 vs. 2017 = 0.116 0.087–0.144)].

Conclusions

Among the few individuals in the United States who receive medication for alcohol use disorder (MAUD), early discontinuation is common, minimizing the opportunity for MAUD to support patients' recovery goals. While MAUD duration has increased in recent years, the improvements are small.

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美国酒精使用障碍药物的停药：患者、处方者和药物预测因素

背景和目的：关于酒精使用障碍（MAUD）依从性的药物治疗知之甚少。本研究的目的是检查与MAUD停药时间相关的患者、处方者和药物特征。设计、环境和参与者：来自Optum实验室的观察性队列研究，对2017年1月至2024年6月开始使用MAUD（纳曲酮、阿坎prosate、双硫仑、托吡酯）的美国商业和医疗保险优惠（Medicare Advantage）患者的行政索赔数据进行了去识别（n = 51 915）。使用加速失效时间（AFT） logistic生存模型，我们检查了MAUD停药情况，调整了患者人口统计学和在开始治疗前或开始治疗之日6个月内建立的临床特征、开始治疗的特定MAUD、MAUD处方者类型和研究年份。我们将至少10%的AFT生存变化（即AFT估计> +/- 0.100）定义为具有临床意义的效应大小。测量方法：MAUD停药时间，定义为药房填充或药物管理的空白期（MAUD天数-供应7天）。结果：在未经调整的分析中，到MAUD停药的中位时间为30天；停药前的中位用药天数因药物而异（如阿坎前列酸和纳曲酮为30天，双硫仑为56天，托吡酯为60天）。调整后的分析显示，在患者特征中，MAUD持续时间较长与年龄较大相关[例如，≥65岁对18-30岁的AFT持续时间估计（95%置信区间）= 0.164(0.088-0.240)]，而较低的县家庭收入中位数与较短的持续时间相关[例如：在美国接受酒精使用障碍（MAUD）药物治疗的少数人中，早期停药是常见的，这使MAUD支持患者康复目标的机会最小化。虽然近年来MAUD持续时间有所增加，但改善幅度很小。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.