Yale University School of Medicine, New Haven, Connecticut.
VISN1 VA New England Mental Illness Research, Education and Clinical Center.
Am J Addict. 2021 Jan;30(1):55-64. doi: 10.1111/ajad.13089. Epub 2020 Aug 17.
Despite substantial evidence of the efficacy of naltrexone in treating alcohol use disorder (AUD), naltrexone is used infrequently and often for short durations. Understanding factors related to the initiation and continued use of naltrexone could identify targets for improving its use in clinical practice.
We used the Fiscal year 2012 national data from the Veterans Health Administration to identify the proportion of veterans diagnosed with AUD who initiated and then continued to receive naltrexone for AUD over a 6-month period (N = 67,788). We further examined correlates of any use and continued use, and patterns of use in inpatient and outpatient mental health services and psychotropic prescription fills. Comparisons were made using bivariate analyses and multinomial logistic regression.
Among the veterans diagnosed with AUD, 2.02% initiated treatment with naltrexone. Naltrexone initiation was associated with recent homelessness, concurrent psychiatric disorders, receipt of psychiatric outpatient services, psychotropic prescription fills, residential treatment, and psychiatric and medical-surgical hospitalization. Of the 1,366 patients initiating naltrexone, 43.2% (590) received 2 to 5 prescriptions and 16.3% (223) received more than 5 prescriptions for naltrexone. Use of naltrexone beyond one prescription was associated with homelessness, major depressive disorder, schizophrenia, psychotropic medication use, and psychiatric hospitalization.
Veterans with AUD who used and continued naltrexone were primarily those with multimorbidity and extensive involvement in psychiatric treatment.
Prior studies examined the correlates of initiation of naltrexone but retention in treatment has received less attention. This study identified the frequency and important patient and service correlates of continued use of naltrexone. (Am J Addict 2021;30:55-64).
尽管有大量证据表明纳曲酮治疗酒精使用障碍（AUD）有效，但纳曲酮的使用频率仍然很低，且通常持续时间较短。了解与纳曲酮起始使用和持续使用相关的因素，可以确定改善其在临床实践中应用的目标。
我们使用 2012 财政年度退伍军人事务部的全国数据，确定在 6 个月期间内诊断为 AUD 的退伍军人中，开始接受纳曲酮治疗然后继续接受纳曲酮治疗的比例（N=67788）。我们进一步检查了任何使用和持续使用的相关性，以及在住院和门诊心理健康服务以及精神药物处方填写方面的使用模式。比较采用了双变量分析和多项逻辑回归分析。
在被诊断患有 AUD 的退伍军人中，有 2.02%的人开始接受纳曲酮治疗。纳曲酮的起始使用与近期无家可归、同时患有精神障碍、接受精神科门诊服务、精神药物处方填写、住院治疗以及精神科和内科手术住院有关。在开始使用纳曲酮的 1366 名患者中，有 43.2%（590 人）接受了 2 至 5 次处方，16.3%（223 人）接受了超过 5 次纳曲酮处方。超过一次处方使用纳曲酮与无家可归、重度抑郁症、精神分裂症、精神药物使用和精神科住院有关。
使用和持续使用纳曲酮的 AUD 退伍军人主要是那些患有多种疾病且大量参与精神科治疗的退伍军人。
先前的研究检查了纳曲酮起始使用的相关性，但治疗保留问题受到的关注较少。本研究确定了纳曲酮持续使用的频率以及重要的患者和服务相关性。（美国成瘾杂志 2021；30:55-64）。
