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

Authors
  • Earlywine, Joel J1
  • Bagley, Sarah M2
  • Rodean, Jonathan3
  • Zima, Bonnie T4
  • Chadi, Nicholas5
  • Leslie, Douglas L6
  • Hadland, Scott E7
  • 1 Mathematica, Seattle, Washington; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
  • 2 Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
  • 3 Children's Hospital Association, Lenexa, Kansas.
  • 4 UCLA-Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California.
  • 5 Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada. , (Canada)
  • 6 Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
  • 7 Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: [email protected].
Type
Published Article
Journal
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
Publication Date
Nov 01, 2023
Volume
73
Issue
5
Pages
845–851
Identifiers
DOI: 10.1016/j.jadohealth.2023.03.005
PMID: 37256254
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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