Heavy drinking begins in adolescence and is a risk factor for the development of alcohol use disorder (AUD). Evidence from clinical trials in adults suggests that providing young adults with evidence-based medications for AUD may encourage their participation in treatment and improve clinical outcomes.
But when and if these drugs are needed? In a review of claims among Medicaid-insured youth in 15 US states, a team of researchers found that most youth with AUD do not receive treatment as part of their treatment.
A group led by Scott Hadland, MD, MPH, a pediatric and young adult physician at Mass General for Children, recently published their findings. Journal of Adolescent Health.
FDA-approved medications for AUD include naltrexone, acamprosate, and disulfiram—all of which are effective in helping with retention. abstinence AUD among adults. Although these drugs are currently approved for adults 18 and older, the Substance Abuse and Mental Health Services Administration recommends considering them for teens under 18 as well.
To study whether and how these drugs were used, the team looked at Medicaid claims data for 4.7M youth ages 13-22 in 15 states. From that cohort, approximately 14,000 youth with AUD were identified during the study period (2014 to 2019) and met the inclusion criteria.
Of this group, 10,851 or 76.4% received AUD treatment within 30 days of diagnosis. Most of them -; About 98% -; They received behavioral health services as treatment. Only 2% of youth received AUD medication on its own or in conjunction with behavioral health treatment.
The findings point to an opportunity to improve drug access to these vulnerable populations, the researchers said.
Treating addiction as early as possible is critical to preventing life-long problems, and not providing medication to youth with alcohol problems can mean a missed opportunity. Without medication, we know that psychosocial interventions can be limited Effectiveness For some patients, pharmacotherapy can clearly reduce alcoholism in adults.”
Scott E. Hadland, senior author of the study, Massachusetts General Hospital
“While these three drugs are only FDA-approved for people over the age of 18, we know they effectively reduce alcohol cravings and are associated with serious drinking problems in this older population,” Hadland pointed out. “Clinical trials are urgently needed to evaluate the effectiveness of these AUD medications in adolescents under 18 years of age, but in our study, even young adults aged 18 to 22 years did not receive medication despite having an important role in treatment.”
A global leader in educating other pediatricians and general practitioners about adolescent mental health and substance abuse, Hadland believes policymakers and clinicians have a critical role to play in increasing public access to drug treatment for alcoholism.
Strategies to increase drug use, especially for adolescents, include ongoing clinical practice and intensive training in AUD screening, screening and treatment during medical school and residency, the research team wrote.
“Alcohol use disorder medications are underutilized in all age groups,” Hadland emphasized, “and stronger addiction training for clinicians is needed, with better reimbursement for medication and alcohol treatment to encourage clinicians to provide evidence-based care.”
Hadland is an associate professor of pediatrics at Harvard Medical School. Lead author Joel Earlewin is an accounting health policy analyst.
The study was funded by the National Institute on Drug Abuse (NIDA).