Predictors of treatment initiation for alcohol use disorders in primary care

• Published in: Drug and alcohol dependence 2018-10, Vol.191, p.56-62
• Main Authors: Watkins, Katherine E., Ober, Allison, McCullough, Colleen, Setodji, Claude, Lamp, Karen, Lind, Mimi, Hunter, Sarah B., Chan Osilla, Karen
• Format: Article
• Language: English
• Subjects: Adult; Alcohol Deterrents - therapeutic use; Alcohol related disorders; Alcohol use; Alcohol use disorder; Alcoholism; Alcoholism - therapy; Alcohols; Behavior disorders; Bivariate analysis; Brief therapy; Brief treatment; Clinical trials; Data analysis; Data processing; Disorders; Drug therapy; Extended-Release injectable naltrexone; Female; Health care; Health facilities; Health services; Homeless people; Homelessness; Humans; Integrated care; Male; Middle Aged; Multivariate Analysis; Naltrexone; Naltrexone - therapeutic use; Opioids; Patient Acceptance of Health Care - statistics & numerical data; Primary care; Primary Health Care - statistics & numerical data; Psychotherapy, Brief - statistics & numerical data; Race; Substance abuse treatment; Substance use disorder; Talking; Time Factors; Treatment utilization
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2018.06.021

•In addition to need, patient factors predicted primary-care based alcohol treatment.•Previously talking with a professional predicted subsequent treatment.•Receiving brief therapy may help patients accept pharmacotherapy.•Being homeless was a negative predictor of primary-care based alcohol treatment. We identified predictors of receiving treatment (brief therapy [BT] and/or extended-release injectable naltrexone [XR-NTX]) for the treatment of alcohol use disorders (AUDs) in primary care. We also examined the relationship between receiving BT and XR-NTX. Secondary data analysis of SUMMIT, a randomized controlled trial of collaborative care. Participants were 290 individuals with AUDs who reported no past 30-day opioid use and who were receiving primary care at a multi-site Federally Qualified Health Center. Bivariate and multivariate analyses examined predictors of BT and/or XR-NTX. Thirty-two percent (N = 93) received either BT or XR-NTX, 28% (N = 82) received BT and 13% (N = 37) received XR-NTX; 9% (N = 26) received both BT and XR-NTX. Older age, white race, talking with a professional about alcohol use and having more negative consequences all predicted receipt of evidence-based treatment; being homeless was a negative predictor. The predictors of receiving BT included not being homeless and previously talking with a professional; the predictors of receiving XR-NTX included older age, white race and experiencing more negative consequences. In 80% of those who received both BT and XR-NTX, receipt of BT preceded XR-NTX. Patient factors were important predictors of receiving primary-care based AUD treatment and differed by type of treatment received. Receiving BT was associated with subsequent use of XR-NTX and may be associated with a longer duration of XR-NTX treatment. Providers should consider these findings when considering ways to increase primary-care based AUD treatment.