Few interventions improve posthospitalization follow-up for alcohol use disorder

1. In this systematic review, only 8 of 21 interventions were effective in improving posthospitalization follow-up for alcohol use disorder (AUD).

2. Most effective interventions incorporated behavioral strategies, and all included a care coordination component.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Treatments for alcohol use disorder (AUD) include medications, mutual-help groups, and psychosocial interventions such as cognitive behavioral therapy and contingency management. However, only approximately 7% of US adults with AUD receive treatment, while hospitalizations for alcohol-related complications continue to rise, particularly among individuals with lower socioeconomic status, more severe AUD, and greater comorbidity. Furthermore, fewer than half of patients hospitalized with AUD attend outpatient follow-up. This systematic review evaluated interventions designed to improve attendance at follow-up AUD care after hospitalization. Among 21 interventions assessed, most incorporated behavioral or care coordination components. Only 8 demonstrated a modest but clinically meaningful improvement in outpatient follow-up. These interventions most commonly included behavioral strategies or care coordination, such as discharge planning and patient outreach. Social support was incorporated into 4 interventions, 3 used mailed letters or telephone calls to encourage appointment attendance, and 1 involved initiation of medications for AUD (MAUD). Among 15 interventions with comparable effect estimates, effects ranged from an 8% absolute decrease to a 30% absolute increase in follow-up, with statistically significant improvements observed in 4 interventions. Of the 12 randomized controlled trials included, 10 were at high risk of bias. Generalizability was limited by the inclusion of only English-language studies, predominantly conducted in the United States, and variable definitions of AUD. Overall, few interventions meaningfully improved posthospitalization AUD follow-up, highlighting the need to identify and evaluate strategies that can more reliably facilitate engagement in ongoing care.

Click to read this study in AIM

Relevant Reading: Specialty substance use disorder services following brief alcohol intervention: a meta‐analysis of randomized controlled trials

In-Depth [systematic review and meta-analysis]: This systematic review synthesized evidence on interventions to improve posthospitalization follow-up among adults with AUD. Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL were searched for English-language studies published from 2000 to 2025. Eligible studies included adults with AUD admitted to general or psychiatric hospitals or medically managed withdrawal facilities and evaluated pre- or postdischarge interventions intended to connect patients with outpatient AUD treatment. The primary outcome was attendance at any outpatient AUD treatment after hospitalization. Seventeen studies were included: 12 randomized controlled trials (RCTs; n=1,917), 3 nonrandomized trials (n=459), and 2 cohort studies (n=9,974). Most (65%) were conducted in the United States. Among 21 interventions, 18 (86%) were multicomponent; behavioral and care coordination components were each included in 16 (76%), social support in 7 (33%), and MAUD in 3 (14%). Seven studies evaluating 8 interventions demonstrated modest, clinically meaningful, and statistically significant improvements in outpatient follow-up. Effective interventions commonly incorporated behavioral strategies and care coordination, with some also including social support, postdischarge contact, or MAUD initiation. Among behavioral interventions, 6 of 16 were effective, including strategies involving education, motivational interviewing, or both. Six of 16 care coordination interventions were effective, including discharge planning and more extensive coordination. Follow-up improved with 2 of 3 MAUD interventions, 4 of 7 social support interventions, and 4 of 10 interventions incorporating posthospitalization components. Among 12 RCTs evaluating 15 interventions, absolute risk differences for follow-up ranged from -8% (95% confidence interval [CI], -18% to 2%) to +30% (95% CI, 6%-53%). Four interventions significantly improved follow-up, with absolute increases of 23% to 30%. All included care coordination, 3 included behavioral components, and 3 incorporated posthospitalization touchpoints. These interventions assessed outcomes within 3 months. However, 10 of 12 RCTs (83%) were at high risk of bias. Overall, few interventions consistently improved posthospitalization AUD follow-up, although multicomponent approaches incorporating care coordination, behavioral strategies, and continued postdischarge contact appeared most promising.

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