Perspectives of In-Hospital Intramuscular Naltrexone and Oral Medications for Alcohol Use Disorder: A Study of Addiction Clinicians and Hospitalized Patients

Background

Alcohol-related hospitalizations are rising; however, medications for alcohol use disorder (M-AUD) are underprescribed despite their effectiveness to reduce heavy drinking. In-hospital administration of intramuscular (IM)-naltrexone may reduce negative health outcomes among people with AUD who are unable to take daily MAUD.

Objective

To assess addiction clinicians’ perceptions of offering and administering IM-naltrexone and to assess hospitalized patients’ perspectives on their alcohol use and acceptance of MAUD.

Design

Multi-methods using surveys and semi-structured interviews.

Setting and Participants

Hospital-based addiction clinicians (n = 20) and hospitalized patients with AUD (n = 25) at a university hospital.

Approach

Descriptive statistics were used for quantitative data analysis. Key informants were identified using convenience sampling; inductive and deductive methods were used to analyze interview transcripts.

Key Results

Clinicians reported that offering and administering in-hospital IM-naltrexone was acceptable, appropriate, and feasible before and after it became available to hospitalized patients. Most patients (92%) accepted IM-naltrexone before agreeing to an interview. Themes emerged related to patient’s complicated relationship with alcohol, ranging from minimizing alcohol’s impact on their family and health, to concerns about how alcohol was negatively affecting them and their loved ones. Many acknowledged that alcohol damaged their health, while also describing ambivalence about their alcohol use or being incapable of reducing their alcohol use. Others expressed motivation and assuredness of sobriety with IM-naltrexone. Most reported accepting IM-naltrexone because they hoped it would improve their health and relationships, because it was convenient, and because it offered security over a pill. Others used alcohol to self-manage challenging emotions and had difficulty considering a life without it.

Conclusions

ACS clinicians viewed IM-naltrexone provision favorably. Some patients expressed concern about their alcohol use and its health impacts while others were ambivalent. Despite this, most accepted MAUD. All forms of MAUD should be offered in the hospital to support patients’ recovery goals.