Mark TL, Kranzler HR, Poole VH, Hagen C, McLeod C, Crosse S; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 157.
The MEDSTAT Group, 4301 Connecticut Avenue, NW, Washington, DC 20008, Phone: (202) 719-7832, Fax: (202) 719-7801, E-mail: tami.mark@medstat.com
RESEARCH OBJECTIVE: In December 1994, naltrexone, marketed under the brand name Revia became the first adjunctive medication in almost 50 years to be approved by the Food and Drug Administration for the treatment of alcoholism. Despite evidence of its efficacy in randomized clinical trials, the use of naltrexone is not widespread. This investigation sought to identify possible barriers to the use of naltrexone and other new medications in the treatment of alcoholism.STUDY DESIGN: Two focus groups were conducted in Washington, DC. The first group was comprised of physicians who treat substance abuse. These participants were recruited nationally through membership in the Association for Medical Education and Research in Substance Abuse (AMERSA) and through referrals provided by a physician consultant. The second group was made up of individuals who had been treated for alcoholism within the past three years and were in recovery. This "patient" group was recruited locally through a newspaper advertisement. The physician group was diverse with respect to specialty, geographic location, type of practice and gender; the patient group was diverse with respect to treatment experiences and demographic characteristics. The physician focus group was taped and transcribed; the patient group was not taped in order to protect the confidentiality of participants.POPULATION STUDIED: Two populations were studied: physicians who treat substance abuse; and individuals who had been treated for alcoholism within the past three years and were in recovery.PRINCIPAL FINDINGS: Both physicians and patients identified public and provider lack of information as key reasons why naltrexone has not been used more widely. Other barriers identified by patients included medication side effects, the philosophy of Alcoholics Anonymous (AA), the price of naltrexone, and stigma. In addition, physicians identified the following barriers: high price, 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. The findings from these focus groups will be used to inform the design of a national survey of providers to further elucidate barriers to the use of naltrexone.CONCLUSIONS: Opinions expressed by focus group participants suggest that physicians will not adopt a new innovation based solely on findings from the clinical literature and that other educational and marketing avenues must be pursued in order to produce changes in behavior. In promoting medications, the diverse members of the alcoholism treatment community should be taken into account. In particular, counselors, patients, and AA membership should be considered.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: While the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the broader research community have invested millions of dollars in the development of new alcoholism medications, licensing medications with demonstrated efficacy may not result in significant changes in the treatment of alcoholism. Additional efforts to introduce new medications may be needed before medications become a common part of alcoholism treatment.PRIMARY FUNDING SOURCE: NIAAA grant 1R01AA12146-01A1
Publication Types:
Keywords:
- Alcoholism
- Data Collection
- Focus Groups
- Humans
- Naltrexone
- Pharmaceutical Preparations
- Physicians
- Placebos
- Substance-Related Disorders
- Washington
- utilization
- hsrmtgs
Other ID:
UI: 102273473
From Meeting Abstracts