Clinician Prescribing Practices Involving Medications for Alcohol Use Disorder

Introduction: Despite the heavy toll of alcohol use disorder (AUD) in the U.S., efficacious medications for AUD (MAUD) are rarely used. Minimal research has explored clinician prescribing practices involving MAUD.

Methods: Using a large national database of electronic health records, this cross-sectional analysis, conducted in 2023-2024, identified clinicians with at least 1 prescription order for an FDA-approved MAUD (naltrexone, acamprosate, or disulfiram) for a patient with AUD during 2016-2021. Descriptive statistics captured clinician-level prescribing volume and type of medication prescribed. Logistic regression models estimated the association between clinician characteristics and number of MAUD patients and type of medications prescribed.

Results: Among the 38,626 clinician-years identified in the EHR data (representing 19,840 unique clinicians), 59% prescribed MAUD to a single patient. Psychiatrists (AOR=4.4, 95% CI=3.8, 4.9) and advanced practice providers (AOR=1.8, 95% CI=1.6, 2.0) were significantly more likely than primary care physicians to prescribe MAUD to 4 or more patients. Clinicians in the top tertile in the percentage of patients with a substance use disorder diagnosis were also more likely to prescribe MAUD to more patients (AOR=8.1, 95% CI=7.1, 9.7). These same clinician characteristics were also associated with greater odds of prescribing more than 1 type of AUD medication.

Conclusions: Most clinicians prescribing MAUD in a year did so rarely. Policy and health system change is needed to improve clinicians' pharmacologic treatment of AUD, with a focus on primary care physicians, with whom individuals with AUD may have the most frequent contact.