Opioids dominate the conversation when it comes to Substance Use Disorders (SUDs) and inpatient treatment. However, new data have highlighted that the significant majority of inpatient addiction treatment is for alcohol use, rather than for any illicit substances. [1] This is a significant public health concern, with alcohol use linked to many serious physical and mental health problems. [1]
What the data shows: Alcohol-related disorders accounted for majority inpatient stays
The data were gathered from inpatient stays in 2023 among individuals aged 18-64 with employer-sponsored health insurance. [1] 10% of the total inpatient stays involved treatment for either mental health or substance use disorder. [1] Of these inpatient stays, 54% were for a primary diagnosis of mental health, and 46% for substance use. [1]
Alcohol-related disorders accounted for 74% of inpatient stays for substance use treatment, representing a vast majority. [1] The second most common substance was opioids, accounting for just 14% of inpatient stays, followed by stimulant-related disorders at 6%. Other substances made up the small remainder. [1] This mirrors national data, which has identified that 1 in 10 adults aged 26 and older has alcohol use disorder. [1]
Substance use admissions were much more common in men (68%), but mental health admissions were more prevalent in women. [1] Inpatient stays for substance use treatment can be expensive, with alcohol-related disorders costing an average of $15,900 per inpatient stay, followed by stimulant-related disorders ($14,300) and opioid-related disorders ($14,000). [1]
These figures raise the question of why alcohol, rather than opioids or any other substance, drives so much of the inpatient burden.
Why does alcohol account for so many hospitalizations?
Between 2003 and 2022, alcohol-related emergency department visits doubled. [2] A CDC report tracking this trend found that visits rose 101% among men and 96% among women over this period, with over 5 million emergency department visits for an alcohol-specific cause during 2021-2022 alone. [2] Both the prevalence of alcohol use and the short- and long-term health impacts it can have have led to such a high number of hospitalizations. [1][2]
As alcohol is legal, socially normalized, and easy to access, far more people drink alcohol than use illicit drugs. As a result, the population at risk of alcohol-related harm is much larger than the population using any single illicit substance. Chronic alcohol use can cause cumulative damage to different organ systems, which means the same person could be hospitalized several times for different alcohol-related reasons over the course of their life.
Conditions that lead to alcohol-related hospitalization
Hospitalizations can occur acutely with alcohol use and also due to problems associated with chronic heavy drinking. [3] Acute presentations could include intoxication, alcohol withdrawal, or injuries sustained while intoxicated. [3] Severe cases of alcohol withdrawal can be fatal without prompt treatment. [4] Inpatient detoxification and treatment of coexisting mental health conditions are part of many alcohol-related hospital admissions.
Chronic conditions associated with alcohol use are often more complex and costly. This includes: [3]
- Liver disease, including alcoholic hepatitis and cirrhosis.
- Gastrointestinal bleeding from varices or stomach ulcers.
- Certain cancers, including esophageal, colorectal, and breast cancer. [5]
These individuals will often suffer from multiple different alcohol-related conditions concurrently, making their care even more complex.
The policy gap and why alcohol is overlooked
Despite being the leading cause of substance use inpatient stays, alcohol use disorder is often overlooked when it comes to policies and dedicated funding, with the majority of public health messaging aimed at opioids. This is partly related to the fact that alcohol is legal and widely marketed. This makes it more challenging for alcohol to be seen as a public health threat, as opposed to illicit substances, which are inherently viewed as dangerous because they are illegal.
Additionally, alcohol harms tend to accumulate slowly and less visibly. In contrast, overdose deaths from opioids are more striking and shocking, making addressing this more of a priority for policymakers. This has subsequently led to a considerable amount more funding and focus on addressing opioid use rather than alcohol use disorders, resulting in fewer treatment initiatives for alcohol specifically.
Why early treatment matters
Early treatment is important for alcohol use disorder, as chronic heavy drinking is more likely to lead to physical and mental health problems. The fact that alcohol is so widely consumed and normalized means that many individuals with problematic drinking habits can go under the radar. By identifying those at risk and providing early interventions, some alcohol-related hospital admissions could be avoided.
Early identification of problematic alcohol use via screening in primary care and emergency settings is often the first step. This can then allow for early interventions to be implemented before alcohol use does too much damage, not only leading to better outcomes for the individuals, but also reducing costly hospital admissions.
What this means for clinicians, families, and advocates
For clinicians, this data highlighting the high prevalence of alcohol-related hospital admissions should raise some serious concerns. Clinicians should be encouraged to use screening tools for alcohol use as part of routine consultations, even if alcohol is not thought to be contributing to the current presentation. This can allow for early identification of those at risk of alcohol-related complications.
For families of those affected by problematic alcohol use, it can be helpful to know that you’re not alone, with many other individuals going through similar struggles and requiring inpatient treatment. This can help reduce the stigma associated with seeking help with alcohol use. Recognizing early warning signs, such as escalating tolerance or withdrawal symptoms, can provide an opportunity to encourage treatment before a hospitalization becomes necessary.
For advocates and policymakers, this data should encourage some redirection of funding and public health messaging that have previously been concentrated on opioids toward alcohol use disorder as well. This includes funding for outpatient alcohol treatment and public awareness campaigns that treat alcohol with the same seriousness as other substances.
Final thoughts
The opioid crisis has dominated public health policy for many years. However, this new data shows that alcohol is the substance providing the heaviest burden on hospitals, with increasing rates of emergency department attendance and hospital admissions linked to alcohol use. This is a significant public health concern, but with more funding and increased awareness of the risks of alcohol use, the number of inpatient stays required in the future could be reduced.
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