T32 Postdoctoral Research Fellow Northwestern University, Illinois
Background & Introduction: Alcohol is a leading cause of death and disability worldwide and alcohol-related visits represent 2% of all ED visits in the US. (1) Recent guidelines recommend naltrexone, acamprosate, or gabapentin to treat AUD in the ED. (2) Establishing feasibility for ED-initiated naltrexone to treat AUD is an active area of research. (3,4) However, the current practice patterns of treating AUD in the ED is unknown. The purpose of this study is to describe annual trends in the treatment of people presenting to an ED for an alcohol-related complaint.
Methods: This is a cross-sectional study of ED visits using the National Health Ambulatory Medical Care Survey (NHAMCS) dataset from 2016 to 2022. NHAMCS was a national survey of visits to hospital-based EDs in the US that was conducted annually and employed a multistage probability sampling design. NHAMCS adjusted sampling weights for survey nonresponse within geographic region, urban or rural, and time of year to create an unbiased national estimate of ED visit data. We included ED visits with an alcohol-related “reason for visit” (RFV) or ICD-10 code in the first three positions of the RFV or ICD-10 code from 2016 to 2022. The primary outcome was the proportion of alcohol-related ED visits that resulted in administration or prescription of any MAUD as cited by the American Society of Addiction Medicine: naltrexone, disulfiram, gabapentin, or topiramate.(5) NHAMCS did not have any observations for acamprosate. These data represent medications administered or prescribed during an ED visit regardless of the disposition and does not include medications administered or prescribed during hospitalization. We summarized clinical and demographic characteristics by study year with descriptive statistics. Variables with less than 30 unweighted records were excluded from weighted analyses.
Results: From 2016 to 2022, approximately 2% of all ED visits were related to alcohol in the US. Gabapentin was the most common MAUD given during an alcohol-related ED visit with an overall proportion of 2.5%. The number of alcohol-related ED visits that resulted in receipt of naltrexone, disulfiram, or topiramate were too low to calculate weighted estimates. People presenting to the ED for an alcohol-related visit from 2016 to 2022 were primarily men (70%), Non-Hispanic White (65%) and between the ages of 45-64 (43%). Of these alcohol-related ED visits, 50% were also related to trauma.
Conclusion & Discussion: The primary limitation in this study is the retrospective design and use of survey data. Another limitation was the low sample size of alcohol-related ED visits that resulted in receipt of a MAUD. RFV and ICD-10 codes included acute alcohol intoxication, which likely included people who do not have AUD. Our results suggest that the use of any MAUD during an alcohol-related ED visit is very low which concurs with other research. (5) Naltrexone was given to a person for an alcohol-related ED visit a total of 8 times in the six-year sample, too low to generate weighted estimates, despite naltrexone being the first recommendation for pharmacotherapy to treat AUD in recent guidelines. (2) The results from this study suggest that we might be missing opportunities to treat AUD in the ED, particularly in people presenting to the ED for alcohol and trauma concurrently or people recently seen in an ED. Future research should focus on how to improve access to MAUD in the ED.
References: 1. Esser MB, Idaikkadar N, Kite-Powell A, Thomas C, Greenlund KJ. Trends in emergency department visits related to acute alcohol consumption before and during the COVID-19 pandemic in the United States, 2018-2020. Drug Alcohol Depend Rep. 2022;3:100049. doi:10.1016/j.dadr.2022.100049 2. Borgundvaag B, Bellolio F, Miles I, et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Academic Emergency Medicine. 2024;31(5):425-455. doi:10.1111/acem.14911 3. Anderson ES, Chamberlin M, Zuluaga M, et al. Implementation of Oral and Extended-Release Naltrexone for the Treatment of Emergency Department Patients With Moderate to Severe Alcohol Use Disorder: Feasibility and Initial Outcomes. Ann Emerg Med. 2021;78(6):752-758. doi:10.1016/j.annemergmed.2021.05.013 4. Cowan E, O’Brien-Lambert C, Eiting E, et al. Emergency department–initiated oral naltrexone for patients with moderate to severe alcohol use disorder: A pilot feasibility study. Academic Emergency Medicine. 2025;32(5):488-497. doi:10.1111/acem.15059 5. Alcohol Use Disorder Resource Guide. American Society of Addiction Medicine; 2023. Accessed February 2, 2026. https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/education-docs/aud-resource-guide-2023.pdf?sfvrsn=d87f5b97_1 6. Lebin JA, Hensen C, Lun Z, et al. Predictors of naltrexone prescribing for alcohol use disorder from the emergency department. Alcohol, Clinical and Experimental Research. 2025;49(10):2310-2318. doi:10.1111/acer.70145
Disclosure(s):
Howard Kim, MD, MS: No financial relationships to disclose
Corey Hazekamp, MD: No financial relationships to disclose
Learning Objectives:
Upon completion, participants will have a better understanding of the demographics of people with alcohol use disorder who present to an emergency department in the US.
Upon completion, participants will be able to better describe how often people with alcohol use disorder receive treatment in a US emergency department
Upon completion, participants will be able to describe other factors associated with a person with alcohol use disorder presenting to an emergency department in the US.
