Methods

Data were from 42 739 adults 18 years and older who participated in the 2019 National Survey on Drug Use and Health (NSDUH), providing representative data among US civilian, noninstitutionalized populations,² including sociodemographic characteristics, past-year emergency department (ED) visits, illicit drug use, alcohol use, and receipt of mental health care and any alcohol use treatment (eg, at a specialty facility, ED, private physician’s office, self-help group). Using DSM-IV diagnostic criteria, NSDUH assessed past-year illicit drug use disorder, AUD (DSM-IV dependence or abuse category), and major depressive episode. NSDUH data collection (through personal visits, using audio computer-assisted self-administered interviews) was approved by the institutional review board at RTI International. Respondents provided verbal informed consent.

The 2019 NSDUH is the first nationally representative survey asking respondents with past-year receipt of alcohol use treatment to report whether they used medications (eg, acamprosate, disulfiram, naltrexone oral/long-acting injectable formulations) prescribed by a physician or other health care professional to help reduce or stop alcohol use. The weighted response rate of the 2019 NSDUH was 45.8%.²

We estimated prevalence of MAUD among US adults with AUD. Multivariable multinomial logistic regression modeling was applied to examine associations of using MAUD and differences between using MAUD and receiving non-MAUD alcohol use treatment. We used 2-sided t tests to calculate P values, and significance was set at a P value less than .05. SUDAAN software version 11.0.1 (RTI International) was used to conduct analyses, accounting for NSDUH’s complex design and sampling weights.

Results

Of 42 739 included adults, 22 807 (53.4%) were female. Among US adults in 2019, past-year prevalence of AUD was 5.6% (95% CI, 5.3-6.0), or 14.1 million persons (95% CI, 13.2-15.1). Among the 14.1 million adults with past-year AUD, 7.3% (95% CI, 5.8-8.8), or 1.0 million persons (95% CI, 0.8-1.2), reported receiving any alcohol use treatment in the past year, and 1.6% (95% CI, 0.9-2.3), or 223 000 persons (95% CI, 127 000-319 000), reported using MAUD. Among the 7.9 million adults with past-year alcohol dependence, 2.7% (95% CI, 1.6-3.8) reported using MAUD.

Among adults with past-year AUD, compared with those with no alcohol use treatment, using MAUD was associated with residing in large metropolitan areas (adjusted odds ratio [AOR], 6.2; 95% CI, 1.6-24.0), frequent ED visits (3 or more times; AOR, 6.6; 95% CI, 1.7-25.5), alcohol dependence (AOR, 16.1; 95% CI, 1.8-149.2), and receiving mental health care (AOR, 10.6; 95% CI, 3.1-35.9) (Table). Compared with receiving nonmedication alcohol use treatment, receiving MAUD was associated with residing in large metropolitan areas (AOR, 5.9; 95% CI, 1.3-26.2), frequent ED visits (3 or more times; AOR, 8.9; 95% CI, 2.0-38.6), and receiving mental health care (AOR, 4.3; 95% CI, 1.2-15.8). Receiving nonmedication alcohol use treatment was associated with having an ED visit (AOR, 1.9; 95% CI, 1.1-3.2), alcohol dependence (AOR, 2.6; 95% CI, 1.4-4.9), receiving mental health care treatment (AOR, 2.5; 95% CI, 1.6-3.9), and having illicit drug use disorder (AOR, 2.8; 95% CI, 1.7-4.6).

Table. Multivariable Multinomial Logistic Regression Results Among 3107 US Adults With Alcohol Use Disorder

Discussion

Although guidelines suggest that patients with AUD should be prescribed MAUD and brief counseling as initial therapy or referred for more intensive psychosocial interventions,^3,4 we found that among an estimated 14.1 million adults with past-year AUD in 2019, only 1.6% (or 223 000 persons) used MAUD. Thus, despite the availability of medications with demonstrated efficacy, MAUDs are rarely prescribed to and used by adults with AUD.

Use of MAUD may be associated with greater AUD severity. Adults receiving MAUD were more likely to report receiving mental health care and having more frequent ED visits, consistent with the associations of cooccurring psychiatric and medical disorders with greater AUD severity.^5,6 Adults with AUD who receive mental health care or ED services or who reside in large metropolitan areas may have greater access to MAUD. For those receiving nonmedication alcohol use treatment, using MAUD may improve treatment effectiveness. Although NSDUH is subject to recall and social-desirability biases, our results highlight the urgent need for improving access to and use of MAUD among adults with AUD.

Methods

A representative sample of 42,739 US civilian, non-institutionalized adults aged 18 years and older participated in the 2019 National Survey on Drug Use and Health (NSDUH). The survey gathered data on sociodemographic factors, past-year emergency department (ED) visits, substance use (illicit drugs and alcohol), mental health care utilization, and alcohol use treatment receipt. Past-year diagnoses of illicit drug use disorder, alcohol use disorder (AUD; encompassing DSM-IV dependence or abuse), and major depressive episode were assessed using DSM-IV criteria. Data collection, employing audio computer-assisted self-administered interviews, adhered to IRB-approved protocols at RTI International, with respondents providing verbal informed consent. The 2019 NSDUH uniquely incorporated a query on medication-assisted alcohol use disorder (MAUD) treatment, encompassing physician-prescribed medications (e.g., acamprosate, disulfiram, naltrexone). The survey's weighted response rate was 45.8%.

Prevalence of MAUD among US adults with AUD was estimated. Associations between MAUD use and treatment modality differences were examined using multivariable multinomial logistic regression. Statistical significance was defined as a P value less than .05, determined using 2-sided t tests. Analyses, accounting for the NSDUH's complex sampling design and weights, were conducted using SUDAAN software version 11.0.1.

Results

The sample comprised 22,807 (53.4%) females. The past-year prevalence of AUD was 5.6% (95% CI, 5.3-6.0), representing approximately 14.1 million adults. Among these, 7.3% (95% CI, 5.8-8.8), or 1.0 million individuals, received alcohol use treatment; 1.6% (95% CI, 0.9-2.3), or 223,000, utilized MAUD. Among adults with alcohol dependence, MAUD use prevalence was 2.7% (95% CI, 1.6-3.8).

Compared to those without alcohol use treatment, MAUD use among adults with AUD was significantly associated with residence in large metropolitan areas, frequent ED visits (≥3 visits), alcohol dependence, and mental health care utilization. Similar associations were observed when comparing MAUD to non-medication alcohol use treatment. Non-medication alcohol use treatment was associated with ED visits, alcohol dependence, mental health care treatment, and illicit drug use disorder.

Discussion

Despite clinical guidelines recommending MAUD as initial therapy or referral to intensive interventions, only 1.6% (223,000) of the estimated 14.1 million adults with past-year AUD utilized MAUD. This highlights a significant gap between treatment guidelines and actual practice. MAUD use was associated with greater AUD severity, as evidenced by higher rates of mental health care utilization and frequent ED visits. Greater access to MAUD may be associated with residence in large metropolitan areas or utilization of mental health or ED services. Further research is needed to ascertain the effectiveness of MAUD within non-medication alcohol use treatment contexts. While acknowledging potential recall and social desirability biases inherent in the NSDUH data, these findings underscore the critical need to enhance MAUD access and utilization among adults with AUD.

Methods

This study analyzed data from the 2019 National Survey on Drug Use and Health (NSDUH), encompassing 42,739 adults aged 18 and older. The NSDUH sample represents the US civilian, non-institutionalized population and includes data on sociodemographic factors, past-year emergency department (ED) visits, substance use (illicit drugs and alcohol), mental health care utilization, and alcohol use treatment receipt. Past-year diagnoses of illicit drug use disorder, alcohol use disorder (AUD; based on DSM-IV criteria), and major depressive episodes were assessed. Data collection involved in-person, audio computer-assisted self-administered interviews. The study employed a weighted response rate of 45.8%. Multivariable multinomial logistic regression modeling analyzed the association between medication-assisted AUD treatment (MAUD) and various factors. Statistical significance was set at p < .05, using two-sided t-tests. Analyses accounted for the complex survey design and sampling weights using SUDAAN software version 11.0.1.

Results

The study sample comprised 22,807 (53.4%) females. The past-year prevalence of AUD was 5.6% (95% CI, 5.3-6.0), representing approximately 14.1 million adults. Among those with AUD, 7.3% (95% CI, 5.8-8.8) or 1.0 million individuals received alcohol use treatment, with 1.6% (95% CI, 0.9-2.3) or 223,000 utilizing MAUD. Among adults with alcohol dependence, MAUD use was 2.7% (95% CI, 1.6-3.8). Compared to those without alcohol use treatment, MAUD use was significantly associated with residing in large metropolitan areas, frequent ED visits (3 or more), alcohol dependence, and mental health care utilization. Similar associations were observed when comparing MAUD to non-medication alcohol use treatment. Non-medication alcohol use treatment was linked to ED visits, alcohol dependence, mental health care, and illicit drug use disorder.

Discussion

Despite clinical guidelines recommending MAUD and brief counseling for AUD, this study found that only 1.6% (223,000) of the estimated 14.1 million adults with past-year AUD used MAUD in 2019. MAUD use correlated with greater AUD severity, indicated by higher rates of mental health care and frequent ED visits, consistent with co-occurring disorders. Access to MAUD might be greater in large metropolitan areas or among individuals already receiving mental health care or ED services. The findings highlight the need to improve MAUD access and utilization among adults with AUD.

Methods

Researchers analyzed data from 42,739 adults (18 and older) in the 2019 National Survey on Drug Use and Health (NSDUH). This survey represents the US civilian, non-institutionalized population and included information on demographics, emergency room visits, substance use, mental health care, and alcohol treatment. Past-year substance use disorders were assessed using DSM-IV criteria. Data collection involved in-person interviews, and the study received ethical approval.

The 2019 NSDUH uniquely asked about medication use (like acamprosate, disulfiram, and naltrexone) for alcohol treatment. The survey's response rate was 45.8%.

The study estimated the prevalence of medication-assisted alcohol use disorder (MAUD) treatment. Statistical methods included multinomial logistic regression to examine MAUD use and differences between MAUD and other treatments. Statistical significance was set at a P-value less than 0.05.

Results

Of the participants, 53.4% were female. In 2019, 5.6% of US adults (approximately 14.1 million) had alcohol use disorder (AUD). Of those with AUD, 7.3% (1 million) received alcohol treatment, and 1.6% (223,000) used MAUD. Among those with alcohol dependence, 2.7% used MAUD.

Compared to those without alcohol treatment, MAUD users were more likely to live in large cities, have frequent emergency room visits, have alcohol dependence, and receive mental health care. Compared to other alcohol treatments, MAUD was linked to similar factors. Other treatments were associated with emergency room visits, alcohol dependence, mental health care, and illicit drug use disorder.

Discussion

Current guidelines recommend MAUD and counseling for AUD. However, the study found that only a small percentage (1.6%) of the estimated 14.1 million adults with AUD used MAUD in 2019.

MAUD use may be linked to more severe AUD. Those using MAUD were more likely to have mental health care and frequent emergency room visits. Better access to MAUD may be available in large cities and for those receiving mental health care or emergency services. The study suggests a need to improve access to and use of MAUD for adults with AUD.

Methods

Scientists looked at information from almost 43,000 grown-ups who took part in a big survey about drug and alcohol use in 2019. The survey asked about things like where people lived, if they went to the emergency room, if they used drugs or alcohol, and if they got help for mental health or alcohol problems. The survey used special ways to ask questions and make sure the answers represented all kinds of people in the U.S. People taking part gave permission to have their answers used in the study.

This survey was the first of its kind to ask people if they used special medicines to help with alcohol problems. About 46% of those invited to take the survey actually completed it.

Scientists used math to figure out how many people had problems with both alcohol and medicine use. They checked if using these medicines was linked to other things, like how often people went to the emergency room. They used special computer programs to make sure their calculations were accurate and took into account how the survey was conducted.

Results

More than half the people in the survey were women. The survey showed that about 5.6% of adults had alcohol problems in the past year. That’s about 14.1 million people! Of those, a small number (1.6%) used special medicines to help with their alcohol use. This was about 223,000 people. People who used these medicines were more likely to live in big cities, go to the emergency room often, have other serious alcohol problems, and also get mental health care.

Discussion

Doctors suggest people with alcohol problems should get special medicines and talk to a counselor, but the study showed that very few people actually used these medicines. This means that even though helpful medicines are available, many people aren't getting them. The study also showed that people who did use these medicines tended to have more serious alcohol problems and might need more help. The study also showed that people who used these medications may also have had better access to care. It is important to find ways to help more people get access to these medications.