Interestingly, our findings illustrate that the greatest overall reduction in alcohol-related acute events were observed with methadone. Time-varying confounding cannot be ruled out because these results can be partly explained by the structure of opioid treatment programs (ie, methadone clinics), which frequently monitor alcohol and illicit drug use with urine drug screens. The effectiveness of OUD medications in AUD may be more limited when it is not accompanied by psychosocial interventions, such as relapse-prevention therapy or counseling focused on medication adherence,28 which are seen in opioid treatment programs that dispense methadone. The association between methadone treatment days and alcohol-related events warrants further investigation.
