Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden.

IF 3.7 2区医学 Q1 SUBSTANCE ABUSE Addiction Science & Clinical Practice Pub Date : 2024-05-19 DOI:10.1186/s13722-024-00471-9

Anastasia Månsson, Anna-Karin Danielsson, Hugo Sjöqvist, Toivo Glatz, Andreas Lundin, Sara Wallhed Finn

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Abstract

Background: Alcohol-attributable medical disorders are prevalent among individuals with alcohol use disorder (AUD). However, there is a lack of research on prescriptions of pharmacological treatment for AUD in those with comorbid conditions. This study aims to investigate the utilization of pharmacological treatment (acamprosate, disulfiram and naltrexone) in specialist care among patients with AUD and comorbid medical diagnoses.

Methods: This was a descriptive register-based Swedish national cohort study including 132,728 adults diagnosed with AUD (N = 270,933) between 2007 and 2015. The exposure was alcohol-attributable categories of comorbid medical diagnoses. Odds ratios (OR) were calculated using mixed-effect logistic regression analyses for any filled prescription of acamprosate, disulfiram or oral naltrexone within 12 months post AUD diagnosis.

Results: Individuals with comorbid alcohol-attributable medical diagnoses had lower odds of filling prescriptions for any type of AUD pharmacotherapy compared to those without such comorbidities. Cardiovascular (OR = 0.41 [95% CI: 0.39-0.43]), neurological (OR = 0.52 [95% CI: 0.48-0.56]) and gastrointestinal (OR = 0.57 [95% CI: 0.54-0.60]) diseases were associated with the lowest rates of prescription receipt. The presence of diagnoses which are contraindications to AUD pharmacotherapy did not fully explain the low prescription rate.

Conclusion: There is a substantial underutilization of AUD pharmacotherapy in patients with AUD and comorbid medical disorders in specialist care. Increasing the provision of pharmacotherapy to this group of patients is essential and may prevent morbidity and mortality. There is a need to further understand barriers to medical treatment both from the patient and prescriber perspective.

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瑞典对患有内科疾病的成年人进行酒精使用障碍的药物治疗。

背景：酒精导致的疾病在酒精使用障碍（AUD）患者中很普遍。然而，目前还缺乏对合并症患者进行药物治疗的研究。本研究旨在调查酒精中毒性障碍和合并症患者在专科治疗中使用药物治疗（阿坎酸、双硫仑和纳曲酮）的情况：这是一项以登记为基础的描述性瑞典全国队列研究，研究对象包括 2007 年至 2015 年间确诊为 AUD 的 132728 名成人（N = 270933）。研究对象为可归因于酒精的合并医疗诊断类别。采用混合效应逻辑回归分析法计算了确诊为 AUD 后 12 个月内任何已开具的阿坎酸、双硫仑或口服纳曲酮处方的风险比 (OR)：结果发现：与无酒精相关疾病诊断的患者相比，合并有酒精相关疾病诊断的患者开具任何类型的 AUD 药物治疗处方的几率都较低。心血管疾病（OR = 0.41 [95% CI: 0.39-0.43]）、神经系统疾病（OR = 0.52 [95% CI: 0.48-0.56]）和胃肠道疾病（OR = 0.57 [95% CI: 0.54-0.60]）的处方率最低。存在作为 AUD 药物治疗禁忌症的诊断并不能完全解释处方率低的原因：结论：在专科护理中，对合并有内科疾病的 AUD 患者，AUD 药物治疗的使用率严重不足。为这类患者提供更多药物治疗至关重要，并可预防发病和死亡。有必要从患者和处方医生的角度进一步了解药物治疗的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction Science & Clinical Practice Psychology-Clinical Psychology

CiteScore

3.90

自引率

10.80%

发文量

审稿时长

28 weeks

期刊介绍： Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.