The patterns and extent of prescribing of medications for alcohol relapse prevention in England

21 May 2024

Researchers:

Dr Kim Donoghue, Department of Clinical, Educational and Health Psychology, University College London and Addictions Department, King’s College London

Key findings

  • The rate of prescribing of medications for alcohol relapse prevention was 2.1% in 2013/14, 6.8% in 2014/15 and 7.8% in 2015/16.
  • A greater likelihood of prescription of medications for alcohol relapse prevention was associated with: a later treatment journey year, older age, female gender, white ethnicity, middle regional prevalence of alcohol dependence, greater severity of alcohol dependence, inpatient, Primary Care or residential treatment setting, prior treatment for alcohol dependence, longer treatment journey, more drinking days in the prior 28 days and drinking a higher number of alcohol units in the prior 28 days. Living in a region of England with the lowest alcohol prevalence was associated with a lower likelihood of prescription of medication for alcohol relapse prevention (ARP).

Background

  • Alcohol dependence is a major public health concern in England with annual increases in alcohol-related hospital admissions and deaths.
  • There are three medications that are recommended to support alcohol relapse prevention that are safe, effective and cost-effective.
  • The limited research that is available suggests that these medications are being underutilised in clinical practice in England.
  • In order to gain a better understanding of the extent of the problem, we need better estimates of the rates and patterns of prescribing.
  • This research aimed to determine the pattern and extent of prescribing of medications for alcohol relapse prevention in England.

Methods

  • This research used data extracted from the National Drug Treatment Monitoring System (NDTMS), a reporting system of all service users receiving treatment by specialist community and residential publicly funded drug and alcohol treatment providers in England.
  • Service users aged 18+ with alcohol reported as their primary substance of dependence and completing a treatment journey between April 2013 and March 2016 (N=188,152) were included.
  • Data on the prescription of medications for alcohol relapse prevention during a treatment journey and data on service users’ demographics, treatment and clinical characteristics were extracted.

Findings

  • The rate of prescribing of medications for alcohol relapse prevention was 2.1% in 2013/14, 6.8% in 2014/15 and 7.8% in 2015/16.
  • A greater likelihood of prescription of medications for alcohol relapse prevention was associated with: a later treatment journey year, older age, female gender, white ethnicity, middle regional prevalence of alcohol dependence, greater severity of alcohol dependence, inpatient, Primary Care or residential treatment setting, prior treatment for alcohol dependence, longer treatment journey, more drinking days in the prior 28 days and drinking a higher number of alcohol units in the prior 28 days. Living in a region of England with the lowest alcohol prevalence was associated with a lower likelihood of prescription of medication for alcohol relapse prevention (ARP).

Implications

  • Identification of these low rates of prescribing of medications for alcohol relapse prevention and the association with service user demographics, treatment, and clinical characteristics can inform strategies to increase their use in clinical practice.

Conclusion

  • In England, medications for alcohol relapse prevention are rarely prescribed (e.g. 7.8% in 2015/16) and those prescriptions appear to be associated with specific service user demographics, treatment, and clinical characteristics.