Capsule Commentary on Oslin et al., A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment

Excerpt

Alcohol use disorders (AUDs) are highly prevalent conditions that largely go untreated. Because of this unmet treatment need, the question of whether and for whom alcohol treatment can be successfully delivered in primary care is important. While AUD screening and provision of brief intervention and/or treatment referral as appropriate is encouraged in primary care settings, brief intervention may not be efficacious for patients with heavy alcohol use or dependence,1 and referrals often have low rates of acceptance. This trial by Oslin and colleagues2 suggests that providing more intensive interventions in primary care settings is an alternative to brief intervention and referral. Patients (n = 163) with alcohol dependence were randomized to receive primary care-based Alcohol Care Management (ACM) vs. outpatient addiction specialty care (SC) at three Veterans Affairs (VA) medical centers. Patients randomized to ACM, which consisted of once weekly psychosocial support and encouraged use of oral naltrexone, were much more likely to be engaged in treatment (OR = 5.36, 95 % CI = 2.99, 9.59) and much less likely to drink heavily (OR = 2.16, 95 % CI = 1.27, 3.66) over a 26-weeks course relative to those randomized to SC. Overall abstinence did not differ between conditions. …