Medications to Reduce Alcohol Use and Promote Recovery in Patients with Severe Alcohol Use Disorders Research to Practice Physician Education Module Sarah Bagley Boston University Addiction Medicine Fellowship September 17, 2014 ABAM meeting

Summary Slide Deck: 35 slides Notes for lecturer: not available Handout materials: Jonas 2014 Meta-Analysis Annotated bibliography: Supplement from Jonas article Test questions: 16 questions with explanations and references***

Overview Pharmacotherapy available for alcohol use disorders Medications work but physicians don’t prescribe them 5 Key Points and Main Recommendations based on a case: – Offer to all pts with severe AUDs – Consider patient profile in medication selection – Continue for at least 3 months – Psychosocial treatment – Monitor for adherence and progress

Recommendation 1 Clinicians should offer MAT to all adult patients with severe AUDs SORT Level: A References: Nunes & Levin. JAMA 2004;291:1887 Garbutt JC et al. JAMA 1999;281:1318 Kranzler HR et al. J Clin Psychopharm 2003;23(3) O’Malley SS, Int J Neuropsychopharmacol 2008 Sep 17

Recommendation 2 Clinicians should consider patient profile (co- occurring diseases, medical and psychiatric history, and prior treatment history) and preferences when choosing MAT SORT Level: C References: O’Malley SS et al. Arch Int Med 2003;163: Anton RF et al. JAMA 2006 May 3;295: Anton RF et al. JAMA 2006 May 3;295: Latt NC, et al. Med J Australia 2002;176:

Recommendation 3 The duration of MAT for AUDs should be a minimum of 3 months and then be based on patient rehabilitative progress. SORT Level: C

Recommendation 4 Clinicians should recommend psychosocial treatment for all adult patients on medication for AUDs. SORT Level: C References: Anton RF et al. JAMA 2006 May 3;295:

Recommendation 5 Clinicians should monitor all adult patients on medication for AUDs for adherence with medication, active alcohol use, craving and adherence with psychosocial treatments. SORT Level: C

Dissemination strategy Module designed for formal didactics Examples: – 1-hour classroom lecture or webinar – Available for fellows to use to teach residents and medical students – Module designed to be used in conjunction with landmark paper that ABAM fellows should be familiar with