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• W3163254953 abstract "Low prescription rates of pharmacotherapies limit the potential benefit to population health from treatment of alcohol use disorders. Barriers have been identified at the level of the patient, provider, system and the medicine level. Such challenges can only be overcome by major changes in public policy and targeted investment. These are alarming figures, particularly given the existence of clear recommendations in national guidelines in the United Kingdom [7] and throughout the globe [8]. Alcohol use disorder is a sadly undertreated disorder—far worse than mental or physical disorders—yet with a significant burden of disease. Pharmacotherapy can be a key tool for achieving abstinence or control consumption [9]. We know that successful treatment of AUD yields striking improvements across multiple domains of health and social function. Indeed, recent data from Sweden indicate that naltrexone is associated with lower risk of hospitalization compared with no uptake of any alcohol pharmacotherapy [10]. An integrated set of solutions need to be implemented to increase medicine use and subsequently improve the treatment of AUDs. Multiple barriers at every level of the therapeutic process may need to be addressed, including patient-based, physician-based, system-based and medicine-based barriers [11]. Stigma associated with AUD and strong beliefs about the nature of the disorder and treatment is likely to permeate efforts to identify, evaluate and introduce new treatment. These patient-level barriers may be difficult to overcome without national interventions. Provider interventions appear more feasible and include education and training implementation programmes. Donoghue discusses three programmes to improve uptake of alcohol pharmacotherapy, including multi-faceted and comprehensive outreach programmes to primary care prescribers and service users and also utilizing components demonstrated to be effective in implementation science, such as clinical champions [12]. In addition, system-level strategies could be implemented which focus on AUD as a target area for service development, including establishing treatment uptake targets in public services [11]. Further implementation and health service research is urgently required and is a critical area for ongoing future study. Finally, medicine-based solutions would inevitably increase uptake of treatment and involve the development of more effective and well-tolerated pharmacotherapies [11]. Alcohol pharmacotherapy does not work for every patient. For acamprosate, the number needed-to-treat (NNT) to achieve abstinence is 12 [13]. Similarly, for naltrexone, the NNT for reducing heavy drinking is 12 [13]; that is, 12 patients need to be treated for one to respond favourably. Significant variations between patients clearly exist with regard to treatment efficacy and tolerability that may be due to biological heterogeneity, clinical factors or comorbidities [14]. In order to improve uptake of these medications, it will be critical to invest in research to discover new effective medications and also advance personalized medicine to develop effective strategies for patient selection [9]. Major changes in public policy and targeted investment in alcohol treatment research are required to meet these challenges. With 5.1% of the global burden of disease and injury attributable to alcohol [15] and at a cost of 2.5% of GDP-purchasing power parity among high-income countries [16], investing in improving and scaling-up treatment will assuredly equate to widespread health and economic benefit. None." @default.
• W3163254953 created "2021-05-24" @default.
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• W3163254953 date "2021-05-11" @default.
• W3163254953 modified "2023-10-14" @default.
• W3163254953 title "Commentary on Donoghue: Low prescribing rates of pharmacotherapy for alcohol use disorder limit potential public health impact" @default.
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• W3163254953 doi "https://doi.org/10.1111/add.15532" @default.
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