Improve access to life-saving pharmacotherapy for alcohol dependence
- 1 day ago
- 4 min read
Key takeaways
> Everyone deserves access to the highest possible standard of medical care including pharmacotherapy for alcohol dependence, an evidence-based treatment for alcohol dependence that was found to be effective in reducing drinking as well as symptom severity and cravings.
> Only a fraction of people struggling with alcohol dependence receive this treatment, resulting in missed opportunities to improve health outcomes and reduce health system costs.
> AOD services and GPs should be supported to prescribe pharmacotherapy for alcohol dependence, including investment in service infrastructure and telehealth models of care, as well as growing AOD service prescriber capacity, GP addiction clinical placements, and secondary consultation support. For the best outcomes, pharmacotherapy must be provided alongside wraparound supports, which promote treatment continuation and quality of life.
Evidence for efficacy
Pharmacotherapy for alcohol dependence is proven to reduce alcohol consumption,¹ as well as the intensity of withdrawal symptoms and cravings. It is recommended by the national guidelines as first line treatment for alcohol dependence.²
Access barriers
Only 2.9% of Australians experiencing alcohol dependence are receiving treatment with either naltrexone or acamprosate,³ both listed on the PBS since 2001.⁴ Even when these medicines are prescribed, PBS data shows few patients are receiving the recommended 3-month minimum course.⁵
Access to pharmacotherapy is often constrained by geography and socioeconomic disparities. People experiencing the highest levels of social disadvantage are prescribed pharmacotherapy for alcohol dependence at a rate 5.2 times lower than those in the most advantaged group, and people living in the most remote areas who would benefit from pharmacotherapy for alcohol dependence are up to 9 times less likely to be prescribed it compared with those in major cities.⁶ This is particularly concerning given these very communities are more likely to experience alcohol-related harm.⁷
The median time to first treatment for alcohol dependence is 11 years.⁸ Stigma is a major barrier for those seeking treatment for alcohol dependence especially in smaller rural and regional communities with few primary healthcare providers. GPs also hold concerns about prescribing pharmacotherapy for alcohol dependence given limited specialist support and a lack of specific training⁹ (to our knowledge, current pharmacotherapy training is opioid-specific, with no training resources available in Victoria for pharmacotherapy related to alcohol use).¹⁰
Supporting practitioners to deliver pharmacotherapy, while ensuring wraparound care
To ensure alcohol pharmacotherapy is readily available to those who would benefit from it, person-centred, and stigma-free, standalone training should be developed and its use encouraged during medical training. This should also include increased investment in GP addiction clinical placements to build practitioner capability in prescribing pharmacotherapy for alcohol dependence. Additional investment in secondary consultation provided by addiction medicine specialists and psychiatrists (e.g., the Drug and Alcohol Clinical Advisory Service) is needed to address prescribers’ low confidence, and consideration should be given to how telehealth models can also be used to support primary consultation that improves rural and regional access to alcohol pharmacotherapy.
This could be coupled with increased investment in existing community AOD services, as well as other health service infrastructure (e.g., Pharmacotherapy Area-Based Networks, Hamilton Centre), to support the incorporation of alcohol pharmacotherapy and clearer patient pathways, including those with co-occurring conditions.
A “Treatment Works” public education campaign would promote patient understanding of treatment options and self-advocacy that support the development of individual alcohol dependence treatment plans. Finally, treatment plans should include options for pharmacotherapy as well as counselling and wraparound support that addresses other issues underlying a person’s drinking including social isolation, insecure housing, and mental health concerns. Some people will require support to manage withdrawal symptoms and some may also need longer term intensive rehabilitation support.
Recommendations
Develop standalone alcohol pharmacotherapy training to promote routine alcohol screening in general practice and improve early detection and treatment of alcohol harms and dependence.
Increase investment in service infrastructure and telehealth models of care, including growing AOD service prescriber capacity and patient pathways, GP addiction clinical placements, and secondary consultation support.
Develop a “Treatment Works” public education campaign to promote help-seeking and increase awareness of the existence of effective treatments for alcohol dependence.
References
1 Melissa McPheeters et al, ‘Pharmacotherapy for Alcohol Use Disorder A Systematic Review and Meta-Analysis’ (2023) 330 (17) JAMA 1653.
2 Paul Haber and Benjamin Riordan, Guidelines for the Treatment of Alcohol Problems (Guidelines, No 4, 2021) 156 <https://alcoholtreatmentguidelines.com.au/pdf/guidelines-for-the-treatment-of-alcohol-problems.pdf>.
3 Ebony Quintrell et al, ‘Alcohol Pharmacotherapy Dispensing Trends in Australia Between 2006 and 2023’ (2024) 59(5) Alcohol and Alcoholism 1, 6.
4 Paul Haber and Kirsten Morley, ‘The Impact of Alcohol Pharmacotherapies on Public Health in Australia is Limited by Low Prescribing Rates’ (2016) 26(4) Public Health Research & Practice 1.
5 Ibid.
6 Kirsten Morley et al, ‘Socioeconomic and Geographic Disparities in Access to Pharmacotherapy For Alcohol Dependence’ (2017) 74 (March) Journal of Substance Abuse Treatment 23.
7 ‘National Drug Strategy Household Survey 2022–2023: Use of Alcohol and Other Drugs in Major Cities, Regional Areas, and Remote Areas’, Australian Institute of Health and Welfare (Web Article, 29 February 2024) <https://www.aihw.gov.au/reports/rural-remote-australians/alcohol-drugs-geographic-areas>; Susan Collins, ‘Associations Between Socioeconomic Factors and Alcohol Outcomes’ (2016) 38(1) Alcohol Research 83.
8 Louise Birrell et al, ‘Treatment Rates and Delays For Mental and Substance Use Disorders: Results From the Australian National Survey of Mental Health and Wellbeing’ (2025) 34 (February) Epidemiology and Psychiatric Sciences 1.
9 Caroline Gregory et al, ‘First-line Medications for the Outpatient Treatment of Alcohol Use Disorder: A Systematic Review of Perceived Barriers’ (2021) (September) Journal of Addiction Medicine 1, 2, 6.
10 ‘Pharmacotherapy Training’, Victorian Department of Health (Web Page, 8 July 2025) <https://www.health.vic.gov.au/drugs-and-poisons/pharmacotherapy-training>.
