A missed opportunity: a retrospective cohort study of alcohol use disorder pharmacotherapy in hospitalized patients

INTRODUCTION: Alcohol use disorder (AUD) poses a significant public health challenge. Despite the availability of effective pharmacological treatments, their use during hospitalization remains limited. This study aimed to evaluate the prevalence of medication for AUD (MAUD) during inpatient admissions and assess its association with subsequent emergency department (ED) visits and hospital readmissions. MATERIALS AND METHODS: We conducted a retrospective cohort study using electronic health records from Stanford Health Care (SHC) between 2015 and 2023. Hospitalized adults with a documented diagnosis of AUD (n = 7560) were categorized based on whether they received acamprosate, naltrexone, or disulfiram during admission. Outcomes included ED visits and hospital readmissions at 3- and 12-month follow-up. High-dimensional propensity score (HdPS) matching was used to control for baseline confounders. RESULTS: Only 3% of patients with AUD received pharmacotherapy during hospitalization. After HdPS matching, we compared 131 patients who received MAUD to 131 patients who did not. No statistically significant differences were found in ED visits within 3 months (OR = .83; 95% CI: .45, 1.51) or 12 months (OR = .66; 95% CI: .39, 1.14), nor in hospital readmissions at 3 months (OR = .87; 95% CI: .47, 1.59) or 12 months (OR = .81; 95% CI: .58, 1.12). CONCLUSIONS: MAUD was rarely administered during hospitalization, representing a critical missed opportunity for intervention. While effect estimates favored treated patients, limited sample size precluded definitive conclusions. Efforts to improve implementation of AUD pharmacotherapy in inpatient settings are warranted.