Abstract
Objectives: We tested the hypothesis that poor adherence is associated with a greater risk of alcohol-caused mortality and morbidities within the first year of discontinuing this medication. Materials and Methods: A retrospective cohort study of 3319 individuals who received acamprosate in the East of Scotland in a 10-year period was conducted using a health informatics approach with record linkage of dispensing data, hospital utilization (SMR) and General Register Office of Scotland (GROS) data. The primary outcome was adherence between one to six months after initiating acamprosate medication. The secondary outcome was all-cause morbidities and mortality. Results: Of the total 3319 individuals identified, a good adherence index of >80% was found in 59% of those prescribed acamprosate after three months and 6% after six months. There were significant linear trends of poorer adherence with increased risk of alcohol-caused mortality (Hazard Ratio, HR 1.2), medical morbidities especially neoplasm (HR 4.1) and poisoning (HR 1.4), and psychiatric morbidities especially stress (HR 35.1), psychotic (HR 5.6) and neurotic disorders, and directly alcohol induced conditions (7.4 HR) after adjustment for other factors within a one-year period of initiation of acamprosate treatment. Discussion and Conclusions: Further exploratory studies using this digitalized approach should be encouraged in order to capture role of compliance to acamprosate and other types of medication that are known to reduce relapse into alcohol dependence and its direct relationship to mortality and morbidities in this population.
Highlights
Background and SignificanceAlcohol dependence (AD) is a chronic relapsing disorder, and the 3.3 million deaths every year directly attributed to harmful use of alcohol make it a major challenge to public health
The health impact is most severe amongst young adults, where alcohol attributes to approximately 25% of deaths in the age group 20–39 years [2]
Many benefit from treatment, a low occurrence of treatment-seeking is a common denominator for the majority of people suffering from alcohol use disorder (AUD), a relapsing disorder characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using [3]
Summary
Alcohol dependence (AD) is a chronic relapsing disorder, and the 3.3 million deaths every year directly attributed to harmful use of alcohol make it a major challenge to public health. Findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) show that in the USA only 14.6% of individuals who met lifetime criteria for an AUD reported having received alcohol treatment [4,5]. This denotes that a large group of individuals fail to seek help, are not offered help, or meet other limitations in accessing treatment to recover from their AUD [4,5]. In a systematic review by May et al (2019), three barriers proved to be prominent: shame and stigma, lack of perception of treatment need, and the paradox of both need for and fear of giving up drinking [6]
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