Researchers explored how primary care physicians who have some familiarity with medications for alcohol use disorder (MAUD) make prescribing decisions and identify reasons for the underuse of MAUD in primary care. They interviewed 19 primary care physicians who had recently prescribed MAUD to patients in an outpatient setting. These physicians were selected from a large online database of medical professionals. Participating physicians reported several challenges in prescribing MAUD: (1) they had somewhat negative personal beliefs about the effectiveness of medications and the likelihood of patient adherence; (2) they faced competing demands in primary care that made prescribing medications a lower priority; and (3) there were few positive norms or expectations regarding the use of these medications. To make MAUD prescribing a smaller component of their practice, physicians followed certain "rules of thumb" to select specific patients for these medications. These included recommending the medications to patients who seemed the most motivated to reduce drinking; those with the most severe AUD; and those who were also receiving other treatments for AUD.
What We Know: Over 29 million Americans have alcohol use disorder (AUD), according to the 2019 National Survey on Drug Use and Health. Although there are effective medications for AUD and can be prescribed within primary care, they are prescribed to only a fraction (8.7%) of people with the disorder. Primary care doctors face barriers to prescribing these medications more often.
What This Study Adds: Researchers identified barriers faced by primary care physicians in prescribing medications for alcohol use disorder, including negative beliefs about medication effectiveness and patient adherence, competing demands in primary care, and limited positive norms. Primary care doctors are also selective about which patients they prescribe medications to so that this remains a smaller part of their practice. The authors call for increased focus on the study and development of standardized selection requirements to initiate MAUD.