Rates of prescription orders for United States active duty service members diagnosed with alcohol use disorder

Abstract

Background: Alcohol-use disorders (AUD) pose a significant challenge for the United States (US) military. The US Department of Defense has strongly recommended several medications for use in the treatment of patients with diagnosed AUD. This study assessed the prescription of medications for active duty service members (ADSMs) diagnosed with AUD in the US Military Health System (MHS). Methods: Rates of prescription orders were retrospectively examined from 2010 to 2017 among ADSMs with an incident diagnosis of moderate-to-severe AUD. The rate of prescription orders was defined as the proportion of ADSMs with an ICD-9 or ICD-10 diagnosis code of alcohol dependence who received an order for acamprosate, disulfiram, naltrexone, and/or topiramate at a military treatment facility in the year following their incident diagnosis. Results: ADSMs receiving an order for at least one medication in the year following their incident AUD diagnosis increased from 8.8% in 2010 to 16.2% in 2017 (RR = 1.84, 95% CI, 1.76, 1.93). Oral naltrexone was ordered most frequently among this patient population, while injectable naltrexone, a medication option meant to ease and improve adherence, was ordered for a smaller proportion of patients. Conclusions: Most ADSMs who might benefit from prescriptions for AUD are not receiving them as part of their treatment despite strong clinical evidence and Department of Defense policy support for their use among this cohort.

Keywords:

• Alcohol use disorders
• acamprosate: disulfiram
• medication-assisted treatment
• naltrexone
• topiramate

Ethical approval

The authors conducted this work in compliance with the ethical standards of the relevant national and institutional committees on human experimentation.

Acknowledgments

The authors would like to thank Dr. Fuad Issa of DHA’s Psychological Health Center of Excellence for his support in identifying medications of interest and understanding the context of their use. The authors would also like to thank Dr. Derek Smolenski of DHA’s Psychological Health Center of Excellence for his review and consultation regarding the methods used. This work was not supported by grants or external funding agencies.

Disclosure statement

No potential conflict of interest was reported by the author(s).