Integration of treatment for alcohol use disorder in primary care settings: a scoping review

Michal J. McDowell, MD, MPH

Massachusetts General Hospital, McLean Hospital
Integration of treatment for alcohol use disorder in primary care settings: a scoping review

Scientific Abstract

Background: Alcohol use disorder (AUD) has a staggering burden of disease and represents the most prevalent addiction in the U.S. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include U.S. Food and Drug Administration (FDA) approved pharmacotherapy (acamprosate, disulfiram, naltrexone) as a treatment modality.

Methods: A search was undertaken across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science. Eligibility criteria included: patient population > 18 years old, primary care-based setting, U.S.-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies.

Results: Thirty-five papers were included in the qualitative synthesis, representing 17 primary studies. Primary study sample sizes ranged from 51 to 830,825 participants. Most (53%) studies were randomized controlled trials. Over three-quarters of studies included majority male participants and 41% of studies included a Veterans Affairs site. A minority of studies included a non-pharmacologic intervention for AUD: 47% with brief intervention, 41% with motivational interviewing, and 18% with medical management. A plurality of studies (47%) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acamprosate, and/or disulfiram. Of the 35 total studies included, 69% assessed care initiation and engagement. Fewer studies (17%) explored primary care practices surrounding screening for or diagnosing AUD. Extracted outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (49% for each).

Conclusions: This scoping review offers evidence that integration of AUD care in primary care settings is feasible and may be associated with improved process and outcome measures of care. Future research is needed to understand the varied experiences across care integration models.

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Michal J. McDowell, MD, MPH, Colby J. Hyland, AB, Paul Bain, Haiden A. Huskamp, PhD, Alisa B. Busch, MD