Written by Peter Liu
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In a retrospective study of alcohol withdrawal interventions on Veterans Affairs (VA) hospital inpatients, only discharge to residential treatment centers (RTC) was associated with improved outcomes.
Consider residential treatment programs for inpatients treated for AUD
Treatment for alcohol use disorder (AUD) and its many complications remains a significant part of inpatient hospital care in the U.S. and involves medical stabilization (e.g. treatment for alcohol withdrawal) as well as prevention of AUD relapse on discharge. In this retrospective cohort study of 594 patients treated at 19 VA hospitals for alcohol withdrawal, researchers tracked factors that could influence 30-day readmission rates and 6-month abstinence rates. Notably, prescription of medications to treat AUD (e.g. naltrexone, acamprosate, and gabapentin) were not associated with improvement in 30-day hospitalization (adjusted OR 1.13, 95%CI 0.75-1.73, p=0.56), nor 6-month abstinence (AOR 1.05, 0.66-1.70, p=0.83). Scheduled follow-up appointments to primary care physicians or substance use disorder clinics was also not associated with a clear improvement in these outcomes, nor was initiation of an outpatient treatment program. Only discharge to residential (live-in) treatment programs was associated with improved outcomes (rehospitalization AOR:0.39, 0.18-0.82, p=0.0; abstinence AOR 2.50, 1.33-4.73, p=0.005).
How will this change my practice?
There are several hurdles to applying this study to a general U.S. inpatient population. First, the population was limited to veterans in the VA setting. Next, around 15% of study patients with medications for AUD were prescribed gabapentin, without distinction for non-AUD indications nor dosing, which could significantly reduce the estimated drug effect. Last and most importantly, I have found in my non-VA experience that transfer directly to RTCs from the hospital is often quite difficult to achieve. Barriers include bed availability and local treatment center factors (e.g. location, acceptance of controlled medications, funding, etc.). Only a very small minority of my patients successfully achieve RTC transfer. Nonetheless, this study validates my practice of advocating for transitioning to RTCs when possible for my patients admitted for AUD, despite the many frustrations and challenges.
Source
Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study. J Hosp Med. 2024 Dec;19(12):1122-1130. doi: 10.1002/jhm.13458. Epub 2024 Jul 19. PMID: 39031461
