Measuring receipt of medications and behavioral health services for AUD

Heavy drinking typically begins in adolescence and is a known risk factor for the development of alcohol use disorder (AUD). Data from adult clinical trials suggest that offering evidence-based medications for AUD to young adults may promote their engagement in treatment and improve clinical outcomes.

But are these drugs used when and where they are needed? In a review of Medicated youth claims data from 15 U.S. states, a team of researchers found that most youth diagnosed with AUD were not receiving medication as part of their therapy, despite recommendations national organizations to consider their use.

The team, led by Scott Hadland, MD, MPH, chief of adolescent and young adult medicine at Mass General for Children, recently published their findings in the Journal of Adolescent Health.

FDA-approved drugs for AUD include naltrexone, acamprosate, and disulfiram; all of which have been shown to be effective in helping to maintain abstinence in adults with AUD. Although these medications are currently approved for adults 18 and older, the Substance Abuse and Mental Health Services Administration recommends that they also be considered for adolescents under 18.

To study if and how these drugs were used, the team looked at Medicaid claims data from 4.7 million young people between the ages of 13 and 22 in 15 states. From this group, they identified approximately 14,000 young people who were diagnosed with AUD during the study period (2014 to 2019) and met the criteria for inclusion.

Of this group, 10,851 or 76.4% received treatment for AUD within 30 days of diagnosis. The vast majority – almost 98% – received behavioral health services as treatment. Only 2% of youth received AUD drugs alone or in combination with behavioral health treatment.

The results indicate an opportunity to improve access to medicines for these vulnerable populations, according to the researchers.

Treating addiction as early as possible is key to preventing lifelong problems, and not offering medication to young people with alcohol problems can represent a missed opportunity. Without drugs, we know that psychosocial interventions can have limited effects efficiency for some patients, whereas pharmacotherapy can clearly reduce alcohol consumption in adult alcoholics.”

Scott E. Hadland, Study Lead Author, Massachusetts General Hospital

“Although these three drugs are only FDA-approved for people 18 years of age and older, we know that they are effective in reducing alcohol cravings and are associated with fewer episodes of heavy drinking in this older population,” Hadland points out. “Clinical trials are urgently needed to assess the effectiveness of these AUD drugs in adolescents under 18, but even young adults aged 18-22 in our study rarely received the drugs despite their important role in the treatment.”

Hadland, an international leader in training other pediatricians and general practitioners about youth mental health and addiction, believes that policymakers and clinicians have an important role to play in increasing public access to pharmacology of alcohol dependence.

Potential strategies to increase medication use, particularly for young adults for whom medication is recommended, include continuing education of clinician practitioners and more robust education in screening, diagnosis, and treatment of AUD in medical schools and residencies, writes the research team.

“Medications for alcohol use disorders are underused at all ages,” Hadland points out, “and stronger substance abuse training for clinicians is needed, along with better reimbursement for treatment. addiction and alcoholism to inspire clinicians to provide evidence-based care.”

Hadland is an associate professor of pediatrics at Harvard Medical School. Lead author Joel Earlywine is a health policy analyst at Mathematica.

The study was funded by the National Institute on Drug Abuse (NIDA).