State Medicaid Policies Impeding Access to Effective Drug for Alcohol Abuse

Many states could more effectively address the huge financial and societal burden of alcohol abuse by changing policies that may be inadvertently impeding access to an inexpensive prescription drug known to reduce problem drinking. These findings appear in a new study in the online version of the journal, Health Services Research.

The study by researchers at the University of Wisconsin and Georgetown University examined how state efforts to control spending on Medicaid, the program that provides health care for low-income individuals and families, may be limiting the ability of physicians to treat alcohol addiction with a widely studied generic drug called naltrexone. The research was funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP).

“States should be keen to quickly deal with this problem because today they are spending on average about $1 of every $7 of their revenues dealing with alcohol-related problems like child neglect and violent crime,” says Carolyn Heinrich, a professor of public affairs at the University of Wisconsin-Madison and the study’s lead author. “Naltrexone is certainly not a cure-all, but it can be a powerful therapy, it’s relatively inexpensive and states have the policy levers at hand to increase its availability to alcohol addicts.”

Evidence from clinical trials shows that naltrexone, which blocks a brain receptor associated with a craving for alcohol, makes it easier for alcoholics to stop drinking and stay sober even when the drug is used alone; that is, unaccompanied by counseling or other interventions.

“We know from extensive research that only about 6 percent of people diagnosed as alcohol dependent are getting medication during their treatment and about a third of those who do not get medication cite cost or insurance as the key barrier,” Heinrich says. “Revising certain state policies on prescription drugs is one way to address what is clearly a need for greater access to a clinically-proven and cost-effective treatment.”

Heinrich and her colleague Carolyn Hill, an assistant professor at Georgetown Public Policy Institute, found that treatment providers are more likely to prescribe naltrexone when states institute policies that encourage the use of generic drugs, include generics on their preferred drug lists and reduce drug costs for Medicaid beneficiaries. Conversely, they found naltrexone is less likely to be adopted in states whose policies allow managed care organizations to restrict access to pharmacy networks or limit prescriptions. Other policies that impede naltrexone’s use include restricting the use of Medicaid funds for substance abuse treatment and establishing restrictive Medicaid preferred drug lists.

State policies related to Medicaid prescription drug benefits are seen as critical to determining naltrexone’s availability because Medicaid funds and related block grants constitute the majority of spending, public or private, on substance abuse treatment. One reason for this dominant role is that most alcoholics tend to be poor and lacking in health insurance and thus are dependent on Medicaid for care.

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Bars, Not Liquor Stores, Associated With Heavy Drinking

Bars and nightclubs, but not liquor stores, are linked with excessive alcohol consumption and heavy episodic drinking in adults who live nearby, according to a new study from the Pardee RAND Graduate School in Santa Monica, California.

“Usually people think that liquor stores define a neighborhood’s alcohol consumption, but we didn’t find any relationship between them and problem drinking among the adult population in California,” says author Khoa Truong.

Instead, the investigators say that overall, their findings point to so-called “minor-restricted establishments” -- adults-only bars and nightclubs -- as having the most consistent and sizeable effects on adult problem drinking, even though they accounted for only about six percent of the total number of alcohol retail licenses in the area studied.

After accounting for one’s education level, income, race, and neighborhood sociodemographic characteristics, we found that a higher number of minor-restricted establishments located within one mile from someone’s home is associated with that person’s higher likelihood of binge drinking and consuming excess alcohol, the authors write.

“If the number of minor-restricted establishments increases, on average, from zero to two in a neighborhood, the prevalence of heavy episodic drinking in the past 30 days would increase from 11.1 percent to 14.3 percent among women and from 19.6 percent to 22.0 percent among men; and prevalence of riding with a driver who perhaps had too much to drink would increase from 2.9 percent to 4.1 percent among women and 4.0 percent to 5.5 percent among men,” says Truong.

The investigators were not surprised with the results, they write, because bars, taverns, and night clubs, especially those that do not allow minors, are where social and cultural norms are more likely to accept, if not encourage, excess drinking.

This research raises questions about the effectiveness of policies that target alcohol sales in general, such as a regulation in counties in California that limits the sale of alcohol licenses based on population numbers. For example, California imposes a moratorium on the issuance of alcohol retail licenses when the ratio exceeds one on-sale general license for each 2000 persons and one off-sale general license for each 2500 persons. Truong’s study indicates that limiting the total number of alcohol licenses is not as effective as targeting certain types of licenses, namely those for minor-restricted drinking establishments.

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