Initiation of Medications for Alcohol Use Disorder Among Hospitalized Veterans : A Retrospective Cohort Study

Ann Intern Med. 2026 May 5. doi: 10.7326/ANNALS-26-00089. Online ahead of print.

ABSTRACT

BACKGROUND: Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs).

OBJECTIVE: To describe patterns and factors associated with hospital initiation of MAUD.

DESIGN: Retrospective cohort study.

SETTING: Veterans Health Administration (VHA).

PARTICIPANTS: Veterans hospitalized with a primary diagnosis of AUD in 2022 or 2023.

MEASUREMENTS: Patients had MAUD initiated as an inpatient or within 7 days of discharge. Logistic regression models estimated the predicted probabilities of MAUD initiation based on hospital fixed effects and demographic and clinical characteristics.

RESULTS: Among 29 041 hospitalizations for AUD of veterans without MAUD at baseline in 142 hospitals (median age, 55 years; 94% male), in 8932 hospitalizations (30.8%), MAUD was initiated as an inpatient or within 7 days; MAUDs were naltrexone (57.9%), acamprosate (16.5%), and injectable naltrexone (13.9%). Of MAUD initiations, 6221 (69.6%) were during an inpatient stay and the rest were within 7 days. Of the 6221 inpatient initiations, 97.7% had a prescription for MAUD within 30 days after discharge. In adjusted analyses, MAUD initiation was more likely for hospitalizations with a specialty addiction consultation and those receiving psychiatry versus medicine service. Initiation of MAUD was less likely for persons aged 65 years or older, men, American Indian or Alaska Native versus White veterans, frail veterans, veterans diagnosed with opioid use disorder, and those in the intensive care unit. The median hospital-level rate of MAUD initiation was 29.9% (IQR, 22.6% to 36.3%).

LIMITATION: Generalizability to other health care systems.

CONCLUSION: Within the VHA, 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within 7 days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD.

PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and National Institute on Aging.

PMID:42081820 | DOI:10.7326/ANNALS-26-00089