BARRIERS TO THE USE OF MEDICATIONS TO TREAT ALCOHOLISM

In December 1994, naltrexone, marketed under the brand name Revia, became the first adjunctive medication in almost 50 years approved by the FDA for treatment of alcoholism. Despite the evidence of its efficacy in randomized clinical trials, the use of naltrexone is not widespread. OBJECTIVE: To identify possible barriers to the use of naltrexone and other new medications in the treatment of alcoholism. METHODS: Focus groups were conducted in Washington, DC. The first comprised physicians who treat substance abuse, recruited nationally through a professional association and physician consultant referrals. The second comprised individuals who had been treated for alcoholism in the past three years and were in recovery, recruited locally through a newspaper advertisement. The physician group was taped and transcribed; the patient group was not taped in order to protect confidentiality. RESULTS: Public and provider lack of information were identified as key reasons why naltrexone has not been used more widely. Patients also pointed out medication side effects, the philosophy of Alcoholics Anonymous (AA), the high price of naltrexone, and stigma as barriers. In addition, physicians noted lack of evidence of efficacy in practice, difficulty measuring efficacy in practice, lack of physician time for patient management, patient reluctance to take medication, uncertainty in identifying appropriate patients for naltrexone, and lack of knowledge of and attitudes toward the use of medications among counselors as barriers. The findings will be used to inform the design of a national survey of providers. CONCLUSIONS: The findings suggest that physicians will not adopt innovations based solely on the clinical literature. While millions of dollars have been invested in the development of new alcoholism medications, licensing medications may not result in significant changes in treatment without educational and marketing efforts to promote the medications through the diverse members of the alcoholism treatment community.