Hospital Discharge Prescribing for Alcohol Use Disorder Stays Low, Study Finds

Only about one in nine adults leaving the hospital with an alcohol use disorder (AUD) diagnosis received a new prescription for an FDA-approved medication to treat it, according to a retrospective cohort study published in the Journal of General Internal Medicine. Researchers led by Neela Nataraj and John T. Ratelle examined 4,232 hospitalizations among 2,347 patients treated between 2018 and 2023 at two hospitals within a large academic medical center, and found that new prescriptions for medications for alcohol use disorder (MAUD) were issued at discharge in just 467 hospitalizations, or 11 percent of the total. The finding matters because AUD is pervasive among hospitalized adults and is associated with poor outcomes after hospitalization, while MAUD have been shown to improve clinical outcomes.

Yet prescribing rates at hospital discharge have remained persistently low, and the factors that determine whether a hospitalized patient actually leaves with a prescription were incompletely understood before this analysis. The study's design was straightforward: the team identified all adults hospitalized with an AUD-related diagnosis at the two hospitals, which notably lacked a dedicated inpatient addiction medicine consult service. The primary outcome was a new MAUD prescription at discharge, and the investigators used multivariable analyses with generalized estimating equations to account for patients who had multiple hospitalizations during the study period.

The results painted a picture in which the circumstances of the hospitalization mattered more than the patient's own characteristics. A primary AUD diagnosis was the only patient-level factor associated with receiving a new prescription, with an odds ratio of 1.25 (95 percent confidence interval 1.02 to 1.54). In other words, when AUD itself was the main reason for admission rather than a secondary diagnosis, patients were modestly more likely to leave with medication.

Length of stay showed a graded association with prescribing. Compared with stays of zero to two days, hospitalizations lasting three to four days had an odds ratio of 1.70 (95 percent CI 1.33 to 2.17), stays of five to seven days an odds ratio of 1.47 (95 percent CI 1.08 to 2.02), and stays of eight or more days an odds ratio of 1.37 (95 percent CI 0.98 to 1.91). Consultative support also emerged as a factor.

Hospitalizations that included consultation by care management were associated with higher odds of a new MAUD prescription, with an odds ratio of 1.37 (95 percent CI 1.02 to 1.85). This points to a role for consultative support in the prescribing decisions made during an admission. Which medical service discharged the patient mattered as well.

Discharge from a general medicine teaching service was associated with an odds ratio of 1.41 (95 percent CI 1.09 to 1.83), and discharge from a family medicine service with an odds ratio of 2.07 (95 percent CI 1.52 to 2.81), each relative to discharge from a hospital internal medicine non-teaching team. The authors suggest that service structure and consultative support may represent targets for interventions designed to raise prescribing rates. The overall message of the study is twofold.

First, MAUD prescribing at hospital discharge remains low even at a large academic medical center, confirming a persistent treatment gap for a condition that carries substantial post-hospitalization risk. Second, the factors associated with higher prescribing are largely organizational rather than patient-driven, which means they could in principle be modified through changes to care pathways and consult services. As with any retrospective cohort study, the findings describe associations rather than proven causal effects, and the results come from a single academic medical center without a dedicated inpatient addiction medicine consult service, which may limit generalizability to other settings.

Even so, the analysis provides a concrete map of where the treatment gap is widest and which structural features of hospital care are linked to better access to medications that can improve outcomes for adults with alcohol use disorder.

Subject of Research: Predictors of new prescriptions for alcohol use disorder medications at hospital discharge among hospitalized adults

Article Title: Predictors of Newly Prescribed Medications for Alcohol Use Disorder Among Hospitalized Adults: A Retrospective Cohort Study

Article References: Nataraj, N., Colbenson, G. A., Schroeder, D. R., & Ratelle, J. T. (2026). Predictors of Newly Prescribed Medications for Alcohol Use Disorder Among Hospitalized Adults: A Retrospective Cohort Study. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10829-1

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10829-1

Keywords: alcohol use disorder, medications for alcohol use disorder, hospital discharge, retrospective cohort study, prescribing rates, addiction medicine, care management consultation, length of stay, treatment gap, Journal of General Internal Medicine, Predictors, Newly