依存症研究と治療ジャーナル

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Risk/Benefit Discussion of Alcohol Use Disorder Medications: Behavioral Economic Considerations and General Recommendations

Teofilo Enrique Matos Santana*, Mark Greenwald and Marc I Rosen

Background: Despite the development of several relatively safe and effective medications to treat alcohol use disorder (AUD), underutilization of these medications continues to be a challenge. With other factors, judgments about medications’ risks and benefits can influence prescribers’ practices and patients’ acceptance of these medications. Objective: Describe how behavioral economic principles and presentation of risks/benefits of AUD medications can impact these medications’ utilization and suggest guidelines for how prescribers should describe these medications to patients. Methods: Literature selected by the authors was used in this commentary and formulation of guidelines. Results: Behavioral economic principles relevant to judging risks and benefits of AUD medications include salience, recency, the halo effect, narrative thinking, avoiding cognitive dissonance, and patients’ interoceptive effects. Benefits of reduced alcohol use may be too abstract without elaboration. Medications are more likely to be taken by patients who envision their benefits as salient, prompt, and consistent with other ideas they have about their alcohol use and/or tailored to their psychological state. Explaining risks and benefits using established quantitative and qualitative terms has predictable effects on patients’ perceptions. Risk/benefit discussion should be bi-directional between patient and provider, personalized to issues valued by each patient, and tailored to the individual’s alcoholinduced state. We propose methods to improve information transfer and reduce biased decision making. Conclusion: Whether and how a risk/benefit discussion of AUD medications is conducted can influence utilization of these medications.