- Seventeen studies of 21 interventions provide heterogeneous, low-certainty evidence, with high risk of bias and imprecise results.
- Eight interventions (38%) improved outpatient linkage; effective approaches combined behavioural and care coordination with AUD medication or social support.
- Given substantial morbidity from untreated AUD, high-quality randomised trials are needed to test intervention components and their impact on follow-up.
Ann Intern Med. 2026 Sep 8. doi: 10.7326/ANNALS-26-01312. Online ahead of print.
ABSTRACT
BACKGROUND: Hospitalizations for alcohol use disorder (AUD) are common and morbid. Outpatient follow-up after discharge is critical for reducing alcohol use and subsequent readmissions, but effective interventions to support this transition are unknown.
PURPOSE: To summarize evidence on the effectiveness of hospital-based interventions to improve outpatient follow-up for AUD.
DATA SOURCES: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL (January 2000 to February 2025).
STUDY SELECTION: Two authors independently reviewed abstracts and full-text articles to identify hospital-based trials and cohort studies that evaluated interventions to improve outpatient AUD follow-up versus usual care or an active comparator.
DATA EXTRACTION: Study data were extracted by 2 authors using a standardized template. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and GRADE (Grading of Recommendations Assessment, Development and Evaluation).
DATA SYNTHESIS: Seventeen studies of 21 interventions (12 randomized clinical trials [RCTs] [n = 1917], 3 nonrandomized trials [n = 459], and 2 cohort studies [n = 9974]) were included. Interventions were heterogeneous, and most (85%) included several components: behavioral (76%), care coordination (76%), medication management (14%), and social support (33%). Eight interventions (38%) reported improved linkage to outpatient follow-up. Effective interventions generally combined behavioral and care coordination with AUD medications or social support. Effect sizes across RCTs ranged from an 8% absolute decrease to a 30% absolute increase in outpatient follow-up. The certainty of evidence was low due to the high risk of bias and imprecision of results.
LIMITATION: Only English-language publications were included.
CONCLUSION: Few intervention studies of low certainty improved posthospitalization follow-up for patients with AUD. Given the substantial morbidity associated with untreated AUD, high-quality RCTs testing various components of interventions are needed.
PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42025636943).
PMID:42704903 | DOI:10.7326/ANNALS-26-01312
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