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. 2023 Nov;73(5):845-851.
doi: 10.1016/j.jadohealth.2023.03.005. Epub 2023 May 29.

Medications for Alcohol Use Disorder and Retention in Care in Medicaid-Enrolled Youth, 2014-2019

Joel J Earlywine  1 , Sarah M Bagley  2 , Jonathan Rodean  3 , Bonnie T Zima  4 , Nicholas Chadi  5 , Douglas L Leslie  6 , Scott E Hadland  7
Affiliations

Medications for Alcohol Use Disorder and Retention in Care in Medicaid-Enrolled Youth, 2014-2019

Joel J Earlywine et al. J Adolesc Health. 2023 Nov.

Abstract

Purpose: Alcohol use disorder (AUD) is a pediatric-onset condition needing timely, effective treatment. Medications for AUD are part of nationally recommended treatments for youth. This study measured receipt of medications and behavioral health services for AUD and subsequent retention in care.

Methods: This retrospective cohort study used claims data from > 4.7 million publicly insured youth aged 13-22 years in 15 states from 2014-2019. Timely treatment was defined as receipt of medication (naltrexone, acamprosate, or disulfiram) and/or behavioral health services within 30 days of incident AUD diagnosis. Associations of age and other characteristics with timely treatment were identified using modified Poisson regression. Retention in care (i.e., no period ≥ 60 days without claims) was studied using Cox regression.

Results: Among 14,194 youth with AUD, 10,851 (76.4%) received timely treatment. Only 2.1% of youth received medication (alone or in combination); nearly all (97.9%) received behavioral health services only. Older (aged 16-17 years) and younger adolescents (aged 13-15 years) were 0.13 (95% confidence interval [CI], 0.07-0.26) and 0.24 (95% CI, 0.11-0.51) times as likely, respectively, to receive medications than young adults aged ≥ 21 years. Median retention in care for youth receiving medications was 119 days (interquartile range, 54-321) compared with 108 days (interquartile range, 43-243) for behavioral health services alone (p = .126). Young adults aged ≥ 18 years were 1.12 (95% CI, 1.06-1.18) times as likely to discontinue treatment compared with adolescents aged < 18 years.

Discussion: This study found that more than seven in 10 youth received AUD treatment but only two in 100 received medications. Future studies should further characterize the effectiveness of medications and determine whether low rates of receipt represent underuse.

Keywords: Adolescent; Alcohol use disorder; Retention in care; Substance use disorders; Young adult.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose. The funder/sponsor did not participate in the work.

Figures

Figure 1:
Figure 1:
Retention in Care According to (A) Timely Receipt of Alcohol Use Disorder Medication Within 3 Months of Diagnosis and (B) Age Among Youths
Figure 1:
Figure 1:
Retention in Care According to (A) Timely Receipt of Alcohol Use Disorder Medication Within 3 Months of Diagnosis and (B) Age Among Youths
See this image and copyright information in PMC

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