Impact of Addiction Consult Service on Alcohol Use Disorder Medications and Postdischarge Outcomes

This study aims to evaluate the association between Addiction Consult Service (ACS) involvement and initiation of medication for alcohol use disorder (MAUD), as well as postdischarge outcomes through 90 days, among adults hospitalized with alcohol-related conditions.​.

We conducted a retrospective cohort study at a large academic medical center from 2018 to 2025. The exposure of interest was receipt of an ACS consultation during hospitalization. Primary outcomes were inpatient MAUD initiation, MAUD prescribed at discharge, and a 30-day composite of all-cause readmission, emergency department (ED) visit, or death. Secondary outcomes included readmissions and ED visits at 7, 30, 60, and 90 days, patient-directed discharge, and 90-day mortality.

Among 17,242 eligible admissions, 4428 were included after propensity score matching (2214 ACS; 2214 no ACS). In the matched cohort (mean [SD] age, 47 [13] y; 72.2% male), ACS consultation was associated with a 32.8-percentage-point higher rate of inpatient MAUD initiation and a 7.4-percentage-point higher rate of MAUD prescribed at discharge compared with usual care (inpatient MAUD initiation odds ratio [OR], 10.47; 95% CI, 8.59-12.86; MAUD at discharge OR, 1.47; 95% CI, 1.27-1.69). The 30-day composite outcome occurred less often with ACS consultation, with an absolute reduction of 5.0 percentage points (OR, 0.80; 95% CI, 0.70-0.91).

Compared with usual care, inpatient ACS involvement was associated with higher MAUD initiation and lower 30-day readmission, ED visit, or death, suggesting that ACS may be a promising approach to expanding evidence-based AUD treatment and to improving short-term outcomes.