Reason for Medical Hospitalization Among Adult Alcohol and Drug Abusers

Abstract

This study attempts to identify the associations between types of substance use and particular medical problems as causes of acute hospital admission on an inpatient substance abuse consultation service. Records of all consultations performed from 1994 to 1998 were analyzed. A total of 4,526 complete records were available. Cocaine (p < .01), heroin (p < .001), and injection drug (p < .001) users were more likely to be admitted to the hospital for infection. Both alcohol (p < .001) and marijuana (p < .001) users were more likely to be hospitalized for trauma related injuries. Individuals that used alcohol were also more likely to be admitted for the treatment of gastrointestinal disorders (p < .001). Clinicians who treat patients with these diagnoses should have a high index of suspicion of co-morbid substance use disorders. Effective treatment of substance use disorders can lead to a decrease in medical morbidity, improved outcomes for individual patients, and decreased costs for the health care system.

Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service

“…Substance use disorders (SUD) are associated with non-adherence to medical care and overutilization of hospital and emergency department services (Fuller et al, 2013; Mark et al, 2013; McGeary and French, 2000; Raven et al, 2009; Raven et al, 2010; Schrag et al, 2006; Walley et al, 2012). A number of these hospitalizations result from medical problems caused or exacerbated by substance use problems (Weintraub et al, 2001). Frequent causes of hospitalizations can be directly attributed to substance use, such as overdose, soft tissue infections, endocarditis, and intoxication-related injury or trauma (Weintraub et al, 2001; Macdonald et al, 2003; Takahashi et al, 2003).…”

“…A number of these hospitalizations result from medical problems caused or exacerbated by substance use problems (Weintraub et al, 2001). Frequent causes of hospitalizations can be directly attributed to substance use, such as overdose, soft tissue infections, endocarditis, and intoxication-related injury or trauma (Weintraub et al, 2001; Macdonald et al, 2003; Takahashi et al, 2003). Following trends in opioid use over the last decade, research has found a dramatic increase in nationwide hospitalizations related to serious infections and endocarditis among those with intravenous drug use (Ronan et al, 2016; Wurcel et al, 2016).…”

Cost and Cost Savings of Navigation Services to Avoid Rehospitalization for a Comorbid Substance Use Disorder Population

“…In the context of hospital costs, this additional expenditure is minimal and is an important finding. To better treat patients with SUD, hospitals have begun to incorporate inpatient addiction consultation services to manage comorbid SUDs during hospitalization and to generate referrals to community-based SUD treatment following discharge 15–17. Our findings suggest that SUD treatment referrals and in-hospital addiction consultation services could be expanded to include patient navigation and create cost savings even if NavSTAR was more costly or provided by different staff than in our analysis.…”

“…Participants in both arms received usual care from UMMC and the long-standing addiction consultation service,13 a multidisciplinary team that includes psychiatrists, nurses, addiction counselors, and social workers 15–17. During the study, this team conducted bedside assessments, counselling, motivational interviewing, and referral to SUD treatment (including medications if indicated) for all patients.…”

“…14 Participants in both arms received usual care from UMMC and the long-standing addiction consultation service, 13 a multidisciplinary team that includes psychiatrists, nurses, addiction counselors, and social workers. [15][16][17] During the study, this team conducted bedside assessments, counselling, motivational interviewing, and referral to SUD treatment (including medications if indicated) for all patients. Participants randomized to the NavSTAR arm were also connected to a masters-level social work patient navigator before discharge from the hospital and provided 3 months of patient navigation postdischarge.…”