Addiction Consultation Service Dramatically Increased Receipt of Medication for Alcohol Use Disorder

Hospital admissions for complications related to alcohol use disorder (AUD) are increasing. Medications for AUD (MAUD) are highly effective, yet they remain underutilized. This retrospective cohort study of 215 hospitalized patients with AUD evaluated the effects of an addiction consultation service (ACS) on receipt of MAUD (both while hospitalized and at discharge), compared with 215 propensity matched historical controls. Secondary outcomes were: patient-directed discharge, 7- and 30-day readmission, and 7- and 30-day post-discharge emergency department (ED) utilization.

• Compared with those in the control cohort, significantly more patients seen by the ACS received MAUD during hospitalization (0.9 percent versus 33 percent), and at hospital discharge (2 percent versus 41 percent).
• Among patients seen by the ACS, the odds of receiving MAUD were exceptionally high (adjusted odds ratio, 49.8), compared with the control cohort.
• Compared with outcomes in the control cohort, ACS receipt was not associated with a significant difference in patient-directed discharge, time to hospital readmission, or time to post-discharge ED visit.

Comments: Addiction consult services have repeatedly been associated with improved evidence-based care for patients with substance use disorder. This study provides evidence of this effect among patients with AUD. Despite increasing the provision of evidence-based care for AUD, this ACS was not able to address ED utilization or readmission, perhaps due to the social and structural determinants of health that may mediate patients’ use of hospitalization as an essential safety net service. Hospitalization is a reachable moment and AUD is a chronic illness, so the benefit of an ACS on a health system and its patients may be best captured longitudinally.

Melissa B. Weimer, DO, MCR

Reference: Singh-Tan S, Torres-Lockhart K, Jakubowski A, et al. Addiction consult service and inpatient outcomes among patients with alcohol use disorder. J Gen Intern Med. 2023:1–8.