It's estimated that 29.5 million people over the age of 12 meet the criteria for alcohol use disorder in 2022, and hospital leaders told Becker's that number continues to rise.
"Healthcare costs are increasing because people who have moderate to severe drinking are coming in with all kinds of health symptoms, not just that about alcohol," Amy Oehlert, manager at the Powell Chemical Dependency Center at UnityPoint–Iowa Lutheran Hospital in Des Moines, told Becker's.
Carson Felkel, MD, system medical director for behavioral health at Cincinnati-based Bon Secours Mercy Health, told Becker's that about 50% of their patients with alcohol use disorder are being seen for intoxication, general use disorder or coma; 25% are being treated for alcohol-related medical conditions like pancreatitis, liver disease and heart failure; and 20% are being treated for alcohol withdrawal.
Patients are seeking help through the emergency department, primary care, urgent cares and other points of healthcare contact.
"A lot of times, people try to speak to their primary care physicians or their therapist first," Michele Scasserra, director of substance use counseling services at Blake Recovery Center at Hackensack Meridian Health Carrier Clinic in Belle Mead, N.J., told Becker's.
Experts told Becker's that alcohol use disorder should be treated everywhere but emphasized that primary care was one of the places they focus on providing care from.
"If patients are treated at the primary care level, we see that they don't have to get so sick that they need to come to the emergency department," Susan Hawk, system director for behavioral health at Bon Secours Mercy Health, told Becker's.
Des Moines, Iowa-based UnityPoint Health encourages people to call their local substance use disorder treatment center; however, Ms. Oehlert said they still have many people coming in from the emergency department for alcohol-related treatment. Her team sees anywhere from three to 12 patients a day on the medical floor who need substance abuse treatment.
Improving alcohol use disorder treatment
To address the range of severity with alcohol use disorder, and the number of touchpoints where patients are seeking help, systems are implementing new initiatives to improve care.
At Bon Secours, one of the systemwide key performance indicators is focused on substance use disorder screening, which has further propelled universal screening in the emergency department and primary care, Dr. Felkel said. Bon Secours is also studying the impact of peer recovery specialists in the emergency department. These six paid employees have lived experience with alcohol use disorder and support incoming patients through appointments. The program began in 2020 and has helped 50 patients so far.
Hackensack Meridian Health's Carrier Clinic offers an inpatient treatment facility on campus so those coming into the emergency department can receive substance use counseling from their hospital room.
"The majority of our referred patients come from the emergency room or a hospital. They are a kind of middlemen for alcohol use disorder," Ms. Scasserra told Becker's.
UnitPoint Health system incorporated two of their substance use treatment programs into the electronic health record.
"We want to be able to treat and share substance use disorder information with other co-treating medical providers to the extent that we're allowed by that law and patient's choice," Ms. Oehlert said. "Sometimes patients don't want to share their substance use diagnosis with their other providers, but we try to help them understand that they need their other providers to know what's going on with their alcohol or other drug use to wholly treat their symptoms."
UnityPoint also created new medication order sets for seven substance use treatments. "That's important for hospitalists who aren't specialized in substance use treatment but are often treating patients with co-occurring substance use disorders," Ms. Oehlert said.
The people who need treatment
Experts told Becker's that it's likely every healthcare facility is under-reporting alcohol use.
Some patients are using alcohol to deal with mental health concerns, loneliness and social anxiety. Dr. Felkel said there are also a subset of patients using alcohol to treat pain, and many caregivers are struggling with burnout, especially when caring for a family member with illnesses like Alzheimer's or dementia.
But an overlooked population are healthcare workers themselves.
"It's a known fact that healthcare workers have higher rates of alcohol use and substance misuse," Dr. Felkel said. "Our goal is to de-stigmatize it, and make sure that people know that treatment and entry into recovery is possible. We call it caring for colleagues."