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Medication-Assisted Alcohol Abuse Treatment in Arizona

Alcohol use disorder (AUD) is a significant public health issue affecting Arizonans, causing substantial health, social and economic costs. According to the 2020 National Survey on Drug Use and Health (NSDUH):

  • 5.7% of Arizona adults aged 12 or older (over 320,000 individuals) had past-year AUD.
  • Among those with AUD, only 6.5% received any treatment in the past year.
  • Even binge drinking was more prevalent in Arizona in 2021.
Prevalence of binge drinking among adults aged ≥18 years by state Behavioral Risk Factor Surveillance System United States 2021

Medication-assisted treatment (MAT), which combines FDA-approved medications, counseling, and behavioral therapies, is one of the most effective approaches for treating alcohol use disorder in Arizona.

The Substance Abuse and Mental Health Services Administration (SAMHSA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) guide “Medication for the Treatment of Alcohol Use Disorder: A Brief Guide” provides complete details about Medication-assisted treatment for alcohol abuse disorder that we are going to understand in this blog.

Need for Medication-Assisted Treatment

Historically, AUD (Alcohol Use Disorder) treatment focused primarily on behavioral interventions and social support. Even though there is strong scientific proof that Medication-Assisted Treatment (MAT) works well, many people still strongly resist or oppose using it. The underutilization of MAT has significant negative consequences, as untreated AUD contributes to:

  • High economic costs (over $250 billion annually in the U.S.).

  • Increased healthcare utilization and costs.

  • Reduced workplace productivity.

  • Impaired family functioning and child welfare issues.

  • Higher rates of crime and motor vehicle crashes.

Medications are an important tool to have in addition to psychosocial treatments. Three medications are currently approved by the FDA for treating AUD:

Disulfiram Antabuse for alcohol abuse

1. Disulfiram (Antabuse)

  • Causes unpleasant symptoms (flushing, nausea, vomiting, etc.) when alcohol is consumed
  • Deters drinking by the threat of these reactions if alcohol is consumed
  • Most effective in patients motivated to maintain abstinence who take it under supervision

Naltrexone

2. Naltrexone

  • Blocks opioid receptors involved in the rewarding effects of alcohol, reducing cravings
  • Available as oral tablets taken daily or monthly extended-release injections (Vivitrol)
  • Reduces heavy drinking and increases abstinence in combination with counseling

Acamprosate Campral

3. Acamprosate (Campral)

  • Reduces symptoms of protracted alcohol withdrawal like anxiety, insomnia, restlessness
  • Enhances abstinence and prevents relapse in patients who are abstinent at treatment start
  • Taken three times daily by mouth; available as delayed-release tablets

Effectiveness of MAT for Alcohol Addiction

Numerous clinical trials and real-world studies have demonstrated the efficacy of medication-assisted treatment (MAT) for alcohol addiction:

Oral Naltrexone:

  • Reduces the risk of heavy drinking, defined as 3 or more drinks per day for women and 4 or more for men.
  • In a systematic review combining oral naltrexone with psychosocial treatments, relapse rates were reduced at 3 months: 38% with naltrexone vs 60% with placebo.
  • Short-term outcomes include fewer patients relapsing to alcohol dependence and reduced craving for alcohol.

Extended-Release Injectable Naltrexone:

  • In a 6-month randomized controlled trial, patients receiving a 380 mg dose had a 25% reduction in heavy drinking days compared to placebo.
  • Particularly effective for patients who are able to abstain from alcohol for several days before treatment initiation.

Acamprosate:

  • Primarily reduces negative symptoms associated with alcohol withdrawal, contributing to its efficacy in maintaining abstinence.
  • Effective for patients who are abstinent from alcohol when treatment is initiated and are motivated to maintain abstinence.

Disulfiram:

  • Deters alcohol consumption by causing an unpleasant physical reaction when alcohol is ingested.
  • Effective for patients who are committed to abstinence and willing to take the medication under the supervision of a family member or treatment program.

Overall, MAT options like naltrexone, acamprosate, and disulfiram have shown significant promise in reducing alcohol consumption, maintaining abstinence, and preventing relapse when combined with psychosocial interventions and support. The choice of medication depends on individual patient factors, such as motivation for abstinence, co-occurring disorders, and potential contraindications.

Accessing MAT Services in Arizona

Utilization of medication-assisted treatment (MAT) for alcohol addiction has grown significantly since the Affordable Care Act mandated insurance coverage for substance use disorder treatment. In Arizona, Medicaid (AHCCCS) covers all three FDA-approved medications for Alcohol Use Disorder (AUD) as well as counseling services for members.

arizona opioid substance abuse and mental health facilities

Arizona had over 70+ federally certified Opioid Treatment Programs and Office-Based Opioid Treatment providers in 2021, many of which also offer MAT services for alcohol addiction. Other resources for locating MAT providers in Arizona include:

  • SAMHSA’s Behavioral Health Treatment Services Locator (https://findtreatment.samhsa.gov)
  • NIAAA Alcohol Treatment Navigator (https://alcoholtreatment.niaaa.nih.gov)
  • Arizona Department of Health Services Licensed Facilities Database (https://azdhs.gov/licensing/index.php#databases)

Conclusion

Medication-assisted treatment that integrates pharmacotherapy with behavioral interventions and support is the gold standard for treating alcohol use disorder. MAT has strong evidence showing it increases abstinence, reduces heavy drinking, and improves treatment engagement compared to either medication or behavioral therapy alone. Despite the clear need, MAT for alcohol addiction remains underutilized both nationally and in Arizona. Expanding awareness, access, and affordability of these life-saving treatments is critical to reduce the devastating impacts of AUD. With a strong foundation of research evidence and expanding access, MAT offers hope to the thousands of Arizonans struggling with alcohol addiction.

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