Five-Year Healthcare Utilization and Costs Among Lower-Risk Drinkers Following Alcohol Treatment

Abstract

Introduction Lower-risk drinking is increasingly being examined as a treatment outcome for some patients following addiction treatment. However, few studies have examined the relationship between drinking status (lower-risk drinking in particular) and health care utilization and cost which has important policy implications. Methods Participants were adults with alcohol dependence and/or abuse diagnoses who received outpatient alcohol and other drug treatment in a private, non-profit integrated health care delivery system and had a follow-up interview 6-months after treatment entry (N=995). Associations between past 30-day drinking status at 6 months (abstinence, lower-risk drinking defined as non-abstinence and no days of 5+ drinking, and heavy drinking defined as one or more days of 5+ drinking) and repeated measures of at least one emergency department (ED), inpatient or primary care visit and their costs over 5 years were examined using mixed effects models. We modeled an interaction between time and drinking status to examine trends in utilization and costs over time by drinking group. Results Heavy drinkers and lower-risk drinkers were not significantly different from the abstainers in their cost or utilization at time 0 (i.e. 6 months post intake). Heavy drinkers had increasing odds of inpatient (p<.01) and ED (p<.05) utilization over 5 years compared to abstainers. Lower-risk drinkers and abstainers did not significantly differ in their service use in any category over time. No differences were found in changes in primary care use among the three groups over time. The cost analyses paralleled the utilization results. Heavy drinkers had increasing ED (p<.05) and inpatient (p<.001) costs compared to the abstainers; primary care costs did not significantly differ. Lower-risk drinkers did not have significantly different medical costs compared to those who were abstinent over 5 years. However, post-hoc analyses found lower-risk drinkers and heavy drinkers to not significantly differ in their ED use or costs over time. Conclusion Performance measures for treatment settings that consider treatment outcomes may need to take into account both abstinence and reduction to non-heavy drinking. Future research should examine whether results are replicated in harm reduction treatment, or whether such outcomes are found only in abstinence-based treatment.

Risky Alcohol Use: The Impact on Health Service Use

“…The results found are in accordance with those studies that found that heavy drinkers or alcohol dependent patients are more prone to be admitted to hospitals [9,30] and to emergency departments [5,6,8,18] than light or Comparisons between light and risky drinkers . * p < 0.01 (bonferroni corrected p = 0.001/9 = 0.0011).…”

“…Some studies have described that alcohol-dependent patients have more appointments with general practitioners and a higher rate of hospital admissions compared with alcohol abusers [4] and non-alcohol dependent patients [5,6]. Furthermore, it has been reported that heavy drinkers with and without a diagnosis of alcohol dependence are more predominant in the emergency department and hospital services compared to abstainers [7,8]. However, general population studies have found a negative relationship between alcohol consumption and health service use: increased alcohol consumption was associated with decreased use of health care services [9][10][11].…”

“…Alcohol abuse and dependence are clearly associated with an increased health service use and it has been shown that alcohol reduction and abstention in this specific population reduce health service use [8,18]. However, the impact of risky alcohol consumption on health service use is understudied despite its high importance for public health policy.…”

Clinical Validation of Reduced Alcohol Consumption After Treatment for Alcohol Dependence Using the World Health Organization Risk Drinking Levels

“…Abstinence may be the safest treatment outcome for many individuals, yet low-risk drinking may be a reasonable alternative for some individuals. There is a growing appreciation of the benefits of reducing drinking, even in the absence of total abstinence (Aubin and Daeppen, 2013; Gastfriend et al, 2007), including significant reductions in morbidity and mortality (Laramée et al, 2015), lower health care costs (Kline-Simon et al, 2014), and improved psychosocial functioning (Kline-Simon et al, 2013; Witkiewitz, 2013). Numerous studies have provided evidence of the feasibility of reducing drinking to moderate, non-harmful levels, even among individuals who have previously been diagnosed with AD (Dawson et al, 2005; Hasin et al, 2013).…”

Measures of outcome for stimulant trials: ACTTION recommendations and research agenda

“…Although the ‘low-risk’ drinking group (i.e., those with no HDDs but continued alcohol use) had worse follow-up drinking outcomes than those who were completely abstinent, they fared significantly better than those who had HDDs, thereby validating this non-abstinence based outcome as associated with fewer subsequent psychosocial and physical consequences. This outcome is further supported through: prospective study data indicating the frequency of heavy drinking increased the relative risks of mortality from cardiovascular disease and cancer (Breslow and Graubard, 2008), epidemiologic data indicating individuals with no heavy drinking days had a lower risk for developing alcohol dependence and alcohol use disorders than those who experienced heavy drinking days (Dawson et al, 2007), as well as through data from treatment centers indicating low-risk drinkers were similar to abstinent individuals with respect to long-term psychosocial outcomes (Kline-Simon et al, 2013) and treatment utilization and costs (Kline-Simon et al, 2014). …”