Use of Naltrexone in the Treatment of Alcoholism Nationally in the Department of Veterans Affairs

Background: Naltrexone is one of only two medications currently approved by the Food and Drug Administration for the treatment of alcoholism. We attempted to determine the proportion of patients with a diagnosis of alcoholism who were prescribed naltrexone in the Department of Veterans Affairs healthcare system during a 6-month period and the sociodemographic and clinical characteristics that distinguished them from veterans who were not prescribed naltrexone. Methods: By using Veterans Affairs workload databases, all outpatients diagnosed with alcoholism (International Classification of Diseases, 9th revision, codes 303.xx or 305.00) during a 6-month period (October 2000 to March 2001) were selected (n = 194,001). Patients in this group who were prescribed naltrexone during this period were identified. Logistic regression was used to compare those who were prescribed naltrexone with other alcoholics. Results: In this sample, only 3,705 patients (1.9%) of the 194,001 veterans with an alcohol use disorder were prescribed naltrexone. Logistic regression analysis showed that naltrexone use was associated with comorbid disorders (bipolar disorder, dysthymia, major depressive disorder, posttraumatic stress disorder, and drug abuse) and recent psychiatric hospitalization. African Americans and veterans with organic brain syndromes were less likely to be prescribed naltrexone. Conclusions: These results suggest that prescribers have not embraced reports of naltrexone's efficacy in alcohol dependence, perhaps due to a general disinclination to use medications rather than a specific attitude toward naltrexone, especially in uncomplicated alcoholism.