Hospitals Are Ill-Equipped to Handle an Increase in Patients With Addiction in EDs

Hospitals need to develop better ways to identify and treat patients with alcohol and substance abuse disorders as they represent an increasing percentage of emergency department (ED) visits and hospitalizations in the United States, according to a recent study by researchers at the University of California, San Francisco.

Researchers analyzed data from the National Hospital Ambulatory Medical Care Survey, which is an annual survey administered by the National Center for Health Statistics. Based on patient medical charts, alcohol use disorder and other substance use disorders were identified.

The study, which looked at ED visits from 2014 to 2018, found that adults with alcohol and substance use disorders were visiting the ED at an increased rate of 30%. Additionally, hospitalizations among patients with those disorders increased by 57%.

In fact, during the study period, one out of 11 visits and one out of nine hospitalizations each year was an individual with an alcohol or other substance use disorder.

“These statistics are comparable to common conditions like heart failure, but hospitals and EDs are rarely as equipped to treat addiction as they are to treat cardiovascular diseases,” said Leslie Suen, MD, MAS, of the UCSF Department of Medicine and lead author of the study in a press release.

The study also found that patients with alcohol and other substance use disorders that presented to the ED were more likely to have Medicaid health insurance, have depression, be experiencing homelessness, have received mental health treatment, and present with injury and trauma.

“Illness and death from complications of alcohol and other substance use are increasing nationally,” said Suen. “Hospitals are one place where we can begin to reverse that trend, but we must be prepared to identify and treat these patients while they are in the hospital and continue following and treating them after they are discharged, as well.”

Of note, these estimates are higher or similar than previous national estimates using claims data. This underscores the importance of identifying additional opportunities to address alcohol and other substance use disorder in acute care settings, especially in tandem with other medical concerns but particularly among visits also presenting with injury, trauma, or coexisting depression.