Dissemination, Adoption, and Implementation of Acamprosate for Treating Alcohol Use Disorders

Overview

Journal J Stud Alcohol Drugs

Specialty Psychiatry

Date 2014 Apr 29

PMID 24766759

Citations 7

Authors

Hannah K Knudsen

Paul M Roman

Affiliations

Soon will be listed here.

Abstract

Objective: Acamprosate has been available in the United States for treating alcohol use disorders (AUDs) for nearly a decade, yet few studies have examined its use within AUD treatment organizations. In addition to describing dissemination and adoption of acamprosate, this study provides novel data regarding organizational processes that underlie its implementation within adopting programs.

Method: Data were drawn from interviews with leaders of a nationally representative sample of 307 organizations delivering AUD treatment. Quantitative indicators of organizational characteristics, dissemination, adoption, and implementation of acamprosate, as well as qualitative measures of implementation processes, were measured during face-to-face interviews.

Results: Only 18.0% (n = 55) of sampled organizations had adopted acamprosate for treating AUDs, and adoption was positively associated with accreditation, having a physician on staff, receiving information about acamprosate via pharmaceutical representatives, and learning about this medication from other treatment providers. Within adopting programs, an average of 6.0% of AUD patients were currently receiving acamprosate. Numerous implementation challenges were identified, including appropriate patient selection, patient reluctance to be prescribed acamprosate, suboptimal adherence, its costs, and limited counselor training.

Conclusions: The limited adoption and implementation of acamprosate likely limits the potential public health impact of this adjunct to AUD treatment. Research integrating the perspectives of organizational leaders, medical professionals, and patients is needed to determine whether specific strategies can address the implementation challenges identified in the current study and increase use of acamprosate in specialty AUD treatment settings.

Citing Articles

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The use of off-label medications in substance abuse treatment programs.

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Discovery, Development, and Adoption of Medications to Treat Alcohol Use Disorder: Goals for the Phases of Medications Development.

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The Diffusion of Acamprosate for the Treatment of Alcohol Use Disorder: Results From a National Longitudinal Study.

Knudsen H, Roman P J Subst Abuse Treat. 2015; 62:62-7.

PMID: 26689318 PMC: 4724483. DOI: 10.1016/j.jsat.2015.10.005.

References

Bouza C, Angeles M, Magro A, Munoz A, Amate J . Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction. 2004; 99(7):811-28. DOI: 10.1111/j.1360-0443.2004.00763.x. View

Rosner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M . Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010; (9):CD004332. DOI: 10.1002/14651858.CD004332.pub2. View

Huddle T . Drug reps and the academic medical center: a case for management rather than prohibition. Perspect Biol Med. 2008; 51(2):251-60. DOI: 10.1353/pbm.0.0012. View

Abraham A, Knudsen H, Rothrauff T, Roman P . The adoption of alcohol pharmacotherapies in the Clinical Trials Network: the influence of research network participation. J Subst Abuse Treat. 2010; 38(3):275-83. PMC: 2835814. DOI: 10.1016/j.jsat.2010.01.003. View

Kiefer F, Jahn H, Tarnaske T, Helwig H, Briken P, Holzbach R . Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2003; 60(1):92-9. DOI: 10.1001/archpsyc.60.1.92. View

Velasco E, Espelage W, Faber M, Noll I, Ziegelmann A, Krause G . A national cross-sectional study on socio-behavioural factors that influence physicians' decisions to begin antimicrobial therapy. Infection. 2011; 39(4):289-97. DOI: 10.1007/s15010-011-0137-1. View

Ducharme L, Knudsen H, Roman P . Trends in the adoption of medications for alcohol dependence. J Clin Psychopharmacol. 2006; 26 Suppl 1:S13-9. DOI: 10.1097/01.jcp.0000246209.18777.14. View

Richardson K, Baillie A, Reid S, Morley K, Teesson M, Sannibale C . Do acamprosate or naltrexone have an effect on daily drinking by reducing craving for alcohol?. Addiction. 2008; 103(6):953-9. DOI: 10.1111/j.1360-0443.2008.02215.x. View

Omorphos S, Hanif M, Dunning J . Are prophylactic beta-blockers of benefit in reducing the incidence of AF following coronary bypass surgery?. Interact Cardiovasc Thorac Surg. 2007; 3(4):641-6. DOI: 10.1016/j.icvts.2004.07.014. View

10.

Kumana C, Cheung B, Lauder I . Gauging the impact of statins using number needed to treat. JAMA. 1999; 282(20):1899-901. DOI: 10.1001/jama.282.20.1899. View

11.

Whitworth A, Fischer F, Lesch O, Nimmerrichter A, Oberbauer H, Platz T . Comparison of acamprosate and placebo in long-term treatment of alcohol dependence. Lancet. 1996; 347(9013):1438-42. DOI: 10.1016/s0140-6736(96)91682-7. View

12.

Knudsen H, Abraham A, Roman P . Adoption and implementation of medications in addiction treatment programs. J Addict Med. 2011; 5(1):21-7. PMC: 3045214. DOI: 10.1097/ADM.0b013e3181d41ddb. View

13.

Samet J, Friedmann P, Saitz R . Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Arch Intern Med. 2001; 161(1):85-91. DOI: 10.1001/archinte.161.1.85. View

14.

Fischer M, Keough M, Baril J, Saccoccio L, Mazor K, Ladd E . Prescribers and pharmaceutical representatives: why are we still meeting?. J Gen Intern Med. 2009; 24(7):795-801. PMC: 2695530. DOI: 10.1007/s11606-009-0989-6. View

15.

Rosner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M . Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010; (12):CD001867. DOI: 10.1002/14651858.CD001867.pub3. View

16.

Boothby L, Doering P . Acamprosate for the treatment of alcohol dependence. Clin Ther. 2005; 27(6):695-714. DOI: 10.1016/j.clinthera.2005.06.015. View

17.

Katz D, Caplan A, Merz J . All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving. Am J Bioeth. 2010; 10(10):11-7. DOI: 10.1080/15265161.2010.519226. View

18.

Anton R, OMalley S, Ciraulo D, Cisler R, Couper D, Donovan D . Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006; 295(17):2003-17. DOI: 10.1001/jama.295.17.2003. View

19.

Mark T, Kranzler H, Song X, Bransberger P, Poole V, Crosse S . Physicians' opinions about medications to treat alcoholism. Addiction. 2003; 98(5):617-26. DOI: 10.1046/j.1360-0443.2003.00377.x. View

20.

Carroll K, Kosten T, Rounsaville B . Choosing a behavioral therapy platform for pharmacotherapy of substance users. Drug Alcohol Depend. 2004; 75(2):123-34. PMC: 3668430. DOI: 10.1016/j.drugalcdep.2004.02.007. View