Service delivery and pharmacotherapy for alcohol use disorder in the era of health reform: Data from a national sample of treatment organizations

ABSTRACT

Background: Although there is a growing literature examining organizational characteristics and medication adoption, little is known about service delivery differences between specialty treatment organizations that have and have not adopted pharmacotherapy for alcohol use disorder (AUD). This study compares adopters and nonadopters across a range of treatment services, including levels of care, availability of tailored services for specific populations, treatment philosophy and counseling orientations, and adoption of comprehensive wraparound services. Methods: In-person interviews were conducted with program leaders from a national sample of 372 organizations that deliver AUD treatment services in the United States. Results: About 23.6% of organizations had adopted at least 1 AUD medication. Organizations offering pharmacotherapy were similar to nonadopters across many measures of levels of care, tailored services, treatment philosophy, and social services. The primary area of difference between the 2 groups was for services related to health problems other than AUD. Pharmacotherapy adopters were more likely to offer primary medical care, medications for smoking cessation, and services to address co-occurring psychiatric conditions. Conclusions: Service delivery differences were modest between adopters and nonadopters of AUD pharmacotherapy, with the exception of health-related services. However, the greater adoption of health-related services by organizations offering AUD pharmacotherapy represents greater medicalization of treatment, which may mean these programs are more strongly positioned to respond to opportunities for integration under health reform.

KEYWORDS:

• Alcohol pharmacotherapy
• organization of treatment services
• specialty treatment for alcohol use disorder

Author contributions

H.K. reviewed the literature, analyzed the data, interpreted the results, participated in writing the manuscript, and contributed to revising the manuscript. P.R. conceptualized and designed the overarching study, oversaw the collection of data, participated in writing the manuscript, and contributed to revising the manuscript.

Funding

The authors have no conflicts of interest to declare. This study was supported by a research grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA grant R01AA015974), an institute within the National Institutes of Health (NIH). NIAAA had no further role in the design of the study; in data collection, analysis, or interpretation; or the preparation of the manuscript. The authors are solely responsible for the content of the manuscript, which does not represent the official views of the NIH or NIAAA.