Availability of Medications for the Treatment of Alcohol Use Disorder in U.S. Counties, 2016–2019

Abstract

Although numerous studies have examined the geographic availability of medications for opioid use disorder, none have measured the availability of medications for alcohol use disorder (MAUD) in the United States. We examined county-level trends in MAUD offerings in the specialty substance use disorder treatment system and compared MAUD availability with local geographic characteristics and alcohol use disorder treatment need. We constructed annual county-level measures of MAUD availability for 2016-2019 using the National Directory of Drug and Alcohol Abuse Treatment Facilities, determining the number of outpatient facilities offering MAUD in each county (n = 12,568). Two-part, multivariable regression models estimated the association between MAUD availability and temporal trends, census region, urbanicity, and prevalence of excessive drinking. Availability of MAUD increased significantly over the study period. By 2019, 38% of U.S. facilities offered at least one MAUD, 40% of counties had at least one specialty treatment facility offering MAUD, and counties with at least one facility had an average of 3.36 MAUD facilities. Availability was significantly higher in urban counties and in the Northeast (both p < .01), but not in counties with higher prevalence of excessive drinking. We observed large increases in the availability of MAUD in the U.S. specialty treatment system from 2016 to 2019. Although these results are encouraging, a majority (60%) of U.S. counties did not have a specialty outpatient treatment facility that offered MAUD in 2019. Additional efforts are needed to improve availability of MAUD, especially in rural counties and in the southern and midwestern United States.