To determine what patient characteristics and healthcare use patterns are associated with adherence to treatment for alcohol use disorders, researchers analyzed pharmacy records over 6 months from a nationally distributed treatment population to determine prescription adherence* to oral naltrexone. They then measured patient characteristics and health services utilization associated with adherence.

• Of the 1138 persons who filled an initial prescription, only 116 (14.2%) adhered to their prescriptions. More than half (51.8%) did not refill a single prescription.
• Persons who adhered to medication, compared with those who did not, were significantly more likely to be older, to have salaried versus hourly jobs, to be retired, and to be college educated. They were also significantly less likely to have prior alcohol-related pharmacy claims or to have used detoxification services, they had fewer emergency department visits and inpatient admissions for nonalcohol-related health problems, and they had attended more psychotherapy sessions.

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* Defined as having filled prescriptions ≥80% of the time over the 6-month review period.

Commentary by Michael G. Boyle, MA
Nonadherence with medications is common. Many of us have not completed a full course of antibiotic treatment after filling the prescription. Yet, the very high rate of nonadherence to naltrexone in this study suggests that clinicians should learn and apply evidence-based psychosocial interventions (e.g., the community reinforcement approach, couples behavioral treatment) with an increased focus on medication adherence as a component, and also take into account the higher risk of nonadherence associated with some demographic factors.