Date of Degree

12-2025

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Michael D. Moon

Abstract

Alcohol use disorder continues to be significantly undertreated within outpatient behavioral health settings, particularly concerning pharmacological interventions. Despite the presence of robust national clinical guidelines recommending medications such as naltrexone for individuals with moderate to severe dependence, the rates of prescribing these medications remain modest owing to inconsistent screening procedures, limited referral practices, and provider follow-through barriers. This project was implemented at a substance use treatment center in a large metropolitan area to improve adherence to clinical practice guidelines. The purpose of this project was to increase prescribing of naltrexone and improve referral for patients with moderate to severe alcohol use disorder who scored above a one on the Brief Substance Craving Scale. Project goals included 1) enhancing identification and treatment through the systematic use of the Brief Substance Craving Scale during intake and follow-up, 2) improving referrals from licensed chemical dependency counselors to prescribing providers, 3) promoting pharmacological treatment consistent with clinical practice guidelines, and 4) strengthening interdisciplinary communication to support coordinated, evidence-based care.

Interventions involved staff training, Brief Substance Craving Scale implementation, and pharmacotherapy for alcohol cravings. Between March 3 and May 23, 2025, 38 patients of 57 admitted patients were identified with alcohol use disorder. Fifty-two screenings were completed; 17 met referral criteria, resulting in 11 follow-ups. Twelve patients (31.6%) received naltrexone prescriptions. Six missed referrals were attributed to incomplete counselor documentation.

This project led to improved referral practices and moderate improvements in evidence-based pharmacotherapy prescribing. This project also demonstrated that structured, low-cost tools can enhance clinical decision-making and partially narrow the treatment gap in alcohol use disorder. Continued efforts are needed to maintain provider engagement and integrated workflows to sustain advances. Managing cravings is essential to improving patients’ abilities to abstain from alcohol.

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