Understanding Clinician-Reported Variations in Treatment for Alcohol Use Disorder in an Integrated Safety Net Health System

Alcohol use disorder (AUD) affects 29 million people in the United States. There is no consensus on best practices for AUD treatment across clinical service areas. We wanted to understand how clinicians across service areas navigated AUD treatment decisions. We conducted a cross-sectional descriptive survey of AUD treatment practices among 165 clinicians from an integrated, safety-net health system in Denver, Colorado. Participants included prescribing and non-prescribing clinicians from primary care, correctional care, outpatient behavioral health services, inpatient, emergency department (ED), and withdrawal management (n = 165). We asked how often clinicians prescribed medications or recommended behavioral interventions for AUD and how often they considered patient characteristics and social factors when making treatment decisions. Prescription practices varied substantially by service area, with overall preference for naltrexone. Sixty-seven percent of inpatient clinicians reported always/often prescribing naltrexone compared to 17% of ED clinicians. Non-billable behavioral health interventions, including motivational interviewing, demonstrated the most variation across service areas. Eighty-one percent of primary care clinicians reported motivational interviewing compared to 39% of correctional care clinicians. Results present novel insights showing substantial variation in clinical treatment for AUD. This complex landscape could be supported by enhanced clinical decision support systems and decentralized approaches.