Factors Associated with Receipt of Medications for Alcohol Use Disorder in Primary Care Prior to Acute Care Encounters in Southern California
Background: Medications for alcohol use disorder (MAUD) are U.S. Food and Drug Administration (FDA)-approved, evidence-based treatments that increase percent days abstinent, reduce heavy drinking, and decrease alcohol cravings. However, a significant ‘know–do’ gap persists, with MAUD underutilized in health care settings. Primary care represents a critical opportunity for early diagnosis and treatment to prevent disease progression and acute care utilization. Identifying factors associated with MAUD receipt may reveal missed opportunities and inform integration of addiction services within primary care.
Methods: We conducted a retrospective cross-sectional analysis of de-identified electronic health record data from adults aged 18–90 in the substance-related diagnosis (SRD) registry from April 22, 2022, to April 21, 2025, with alcohol-related diagnoses (ARD) in a U.S. health system. Among these, 869 individuals had a primary care visit within six months prior to acute care encounters. The outcome was receipt of MAUD in primary care during this period. Multivariable logistic regression examined associations between sociodemographic, clinical, and social risk factors (components of the SDOH index, e.g., housing instability, food insecurity, transportation barriers) and MAUD receipt, adjusting for comorbidity using the Charlson Comorbidity Index, with sensitivity analyses using the LACE index.
Results: Of the 869 individuals, just 221 (25.4%) received MAUD. A positive HIV status was associated with the highest odds of MAUD receipt (aOR: 54.9; 95% CI: 23.2–154; p<0.001). Social risk factors (aOR: 6.75; 95% CI: 2.63–17.8; p<0.001), moderate (aOR: 3.50; 95% CI: 1.60–7.55; p=0.002) and high comorbidity burden (aOR: 2.34; 95% CI: 1.45–3.82; p<0.001), public insurance (aOR: 1.78; 95% CI: 1.03–3.07; p=0.038), uninsured/self-pay status (aOR: 1.73; 95% CI: 1.08–2.76; p=0.021), and other substance-related diagnoses (aOR: 1.62; 95% CI: 1.06–2.50; p=0.028) were associated with higher odds of MAUD receipt. Older age (aOR: 0.15; 95% CI: 0.07–0.31; p<0.001) and being married/partnered (aOR: 0.54; 95% CI: 0.33–0.85; p=0.009) were associated with lower odds of receipt.
Conclusions: MAUD remains underutilized, with variation in receipt across sociodemographic, clinical, and structural factors. Findings suggest treatment is more often initiated in the context of greater clinical complexity or higher-risk presentations rather than routine early intervention. Strengthening screening and linkage to care may improve MAUD receipt.
