Understanding Indian Doctors' Attitudes Toward Alcohol Pharmacotherapy and Prescription: A Mediational Analysis

Overview

Journal Indian J Psychol Med

Publisher Sage Publications

Specialty Psychiatry

Date 2024 Nov 20

PMID 39564215

Authors

Sanjukta Ghosh

Tamonud Modak

Abhijit Ramdas Rozatkar

Affiliations

Soon will be listed here.

Abstract

Background: Alcohol use disorder (AUD) causes significant morbidity and mortality. Prescription of AUD pharmacotherapies remains low. Attitudes toward AUD pharmacotherapies influence their prescription rates. We conducted an online survey to assess how attitudes modulate the association between knowledge and prescription rates for four commonly used AUD medications among Indian clinicians.

Methods: An online survey was sent nationwide to Indian physicians between February and April 2023 to assess knowledge, attitudes, and practices of various AUD medications. An a priori model was defined to indicate the relationship between study variables. Bootstrapped correlation analysis was conducted to determine confidence intervals of the correlation coefficients between knowledge, attitudes, and prescription practices. Additional subgroup analysis was conducted for faculty and private psychiatrists to assess if they prescribed differently.

Results: A total of 387 physicians responded to the survey. Bootstrapped correlation analysis indicated that safety and acceptability played a moderated prescription rates for acamprosate and naltrexone while they mediating role among faculty. For Disulfiram, perceived efficacy had a mediating effect, especially among private psychiatrists. Among faculty, perceived safety negatively mediated Disulfiram prescriptions. There was no indirect effect of attitudes on the association between knowledge and prescription practices for Baclofen.

Conclusion: The role of attitudes varied across medications. For acamprosate and naltrexone, perceived safety and acceptability significantly moderated prescription rates. For Disulfiram, perceived efficacy played a significant mediating effect. Attitudes did not influence Baclofen prescriptions as a whole, but acceptability significantly mediated prescriptions for private psychiatrists. This might indicate that physicians prescribe Baclofen as an ineluctable option.

References

Im G, Mellinger J, Winters A, Aby E, Lominadze Z, Rice J . Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease: A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group. Clin Gastroenterol Hepatol. 2020; 19(11):2407-2416.e8. PMC: 8291372. DOI: 10.1016/j.cgh.2020.10.026. View

Jyani G, Prinja S, Ambekar A, Bahuguna P, Kumar R . Health impact and economic burden of alcohol consumption in India. Int J Drug Policy. 2019; 69:34-42. DOI: 10.1016/j.drugpo.2019.04.005. View

Meza E, Cunningham J, El-Guebaly N, COUPER L . Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practitioners. Can J Psychiatry. 2001; 46(2):167-72. DOI: 10.1177/070674370104600209. View

Thomas S, Miller P . Knowledge and attitudes about pharmacotherapy for alcoholism: a survey of counselors and administrators in community-based addiction treatment centres. Alcohol Alcohol. 2006; 42(2):113-8. DOI: 10.1093/alcalc/agl100. View

Ghosh S, Modak T, Rozatkar A . A Survey of Medication Diffusion and Attitudes Among Indian Clinicians Toward Pharmacotherapies for Alcohol Use Disorder. Indian J Psychol Med. 2024; 46(6):544-551. PMC: 11558721. DOI: 10.1177/02537176241229197. View

Glass J, Bohnert K, Brown R . Alcohol Screening and Intervention Among United States Adults who Attend Ambulatory Healthcare. J Gen Intern Med. 2016; 31(7):739-45. PMC: 4907945. DOI: 10.1007/s11606-016-3614-5. View

Aletraris L, Edmond M, Paino M, Fields D, Roman P . Counselor training and attitudes toward pharmacotherapies for opioid use disorder. Subst Abus. 2015; 37(1):47-53. PMC: 4879956. DOI: 10.1080/08897077.2015.1062457. View

Ornstein S, Miller P, Wessell A, Jenkins R, Nemeth L, Nietert P . Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings. J Stud Alcohol Drugs. 2013; 74(4):598-604. PMC: 3711350. DOI: 10.15288/jsad.2013.74.598. View

Bhardwaj A, Sousa J, Huskamp H, Busch A, Kennedy-Hendricks A, Hodgkin D . Prescribing Medications for Alcohol Use Disorder: A Qualitative Study of Primary Care Physician Decision Making. Ann Fam Med. 2023; 21(4):332-337. PMC: 10365869. DOI: 10.1370/afm.2997. View

10.

MacKinnon D, Lockwood C, Hoffman J, West S, Sheets V . A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002; 7(1):83-104. PMC: 2819363. DOI: 10.1037/1082-989x.7.1.83. View

11.

Jonas D, Amick H, Feltner C, Bobashev G, Thomas K, Wines R . Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014; 311(18):1889-900. DOI: 10.1001/jama.2014.3628. View

12.

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

13.

Harris A, Brown R, Dawes M, Dieperink E, Myrick D, Gerould H . Effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders in the US Veterans Health Administration. J Subst Abuse Treat. 2017; 82:107-112. DOI: 10.1016/j.jsat.2017.09.002. View

14.

Martel M, Dolman A, Edwards R, Jamison R, Wasan A . The association between negative affect and prescription opioid misuse in patients with chronic pain: the mediating role of opioid craving. J Pain. 2013; 15(1):90-100. PMC: 3877217. DOI: 10.1016/j.jpain.2013.09.014. View

15.

Mark T, Kassed C, Vandivort-Warren R, Levit K, Kranzler H . Alcohol and opioid dependence medications: prescription trends, overall and by physician specialty. Drug Alcohol Depend. 2008; 99(1-3):345-9. PMC: 3166770. DOI: 10.1016/j.drugalcdep.2008.07.018. View

16.

Williams E, Achtmeyer C, Young J, Berger D, Curran G, Bradley K . Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics. J Gen Intern Med. 2017; 33(3):258-267. PMC: 5834954. DOI: 10.1007/s11606-017-4202-z. View

17.

Bernstein E, Pfoh E, Le P, Rothberg M . Relationship Between Primary Care Providers' Perceptions of Alcohol Use Disorder And Pharmacotherapy Prescribing Rates. Alcohol Alcohol. 2022; 58(1):54-59. DOI: 10.1093/alcalc/agac057. View

18.

Bharadwaj B, Selvakumar N, Kuppili P . Pharmacotherapy for relapse prevention of alcohol use disorder in the Indian setting: A systematic review. Ind Psychiatry J. 2019; 27(2):163-171. PMC: 6592216. DOI: 10.4103/ipj.ipj_79_17. View

19.

Andrade C . The Limitations of Online Surveys. Indian J Psychol Med. 2020; 42(6):575-576. PMC: 7735245. DOI: 10.1177/0253717620957496. View

20.

Cotter T, Ayoub F, King A, Reddy K, Charlton M . Practice Habits, Knowledge, and Attitudes of Hepatologists to Alcohol Use Disorder Medication: Sobering Gaps and Opportunities. Transplant Direct. 2020; 6(10):e603. PMC: 7591123. DOI: 10.1097/TXD.0000000000001054. View