Recovery Meds Started in 1 of 5 Alcohol Withdrawal Hospitalizations

Getting through alcohol withdrawal in a hospital is the hard part most people picture. A study of nearly 6,000 such hospitalizations suggests the more consequential gap comes at the other end, when patients are discharged from alcohol detox without the medication that helps them stay stopped.

Researchers found that fewer than one in five alcohol withdrawal hospitalizations resulted in a medication for alcohol use disorder being started. The findings appear in the Journal of Hospital Medicine.

Why Medical Detox Alone Is Not Treatment

Medical detox treats the acute danger. Alcohol withdrawal can produce seizures and delirium tremens and can be fatal, which is why it belongs in a supervised setting rather than at home.

Getting through it does not treat alcohol use disorder. Three medications have been approved by the Food and Drug Administration for that purpose, naltrexone, acamprosate, and disulfiram, and several others are used off-label.

A hospital stay for withdrawal is one of the few moments when someone is already under medical care and a prescription can be started before they leave.

What the Study Found

The team analyzed electronic health record and pharmacy data from 2022 through 2024 across a large health system, covering 5,993 alcohol withdrawal hospitalizations at 12 hospitals. Patients who had already filled one of these medications in the prior 90 days were excluded, so the figures describe new starts.

Overall, 19.8% had a medication for alcohol use disorder initiated, counted as either injectable naltrexone given in the hospital or a discharge prescription for oral naltrexone, acamprosate, disulfiram, topiramate, or baclofen.

Oral naltrexone accounted for the large majority of what was started, at 66.9%. Topiramate was the least used, at 1.2%.

Where Someone Is Treated Changes What They Get

The most striking number is the spread between hospitals. Initiation ranged from 5.1% at the lowest site to 43.2% at the highest, an eightfold difference within a single health system.

Four hospitals started medication at significantly lower rates than average and two at significantly higher rates. The only hospital in the system with an addiction consult service was among the higher performers.

Patients aged 65 and older were less likely than patients aged 18 to 29 to have medication started, by 6.89 percentage points after adjustment.

The authors concluded that initiation was low and varied by both patient characteristics and hospital site, and that understanding what drives the variation could guide efforts to close the gap.

What This Means If You Are Choosing a Program

This is a question worth asking out loud before an admission, or during one. Ask whether the program starts medication for alcohol use disorder during the stay or only refers out afterward.

Ask whether an addiction medicine clinician will see the patient, since the site with that service performed better here. Ask who writes the discharge prescription and who schedules the first follow-up appointment.

If a patient is older, ask the question more directly. The age pattern in this study suggests assumptions sometimes get made about who is a candidate.

Finding Alcohol Detox and Ongoing Treatment

Never attempt alcohol or benzodiazepine detox without medical supervision. Withdrawal from either can be life-threatening, and the risk rises with each prior withdrawal episode.

Detox.com can help you find medically supervised alcohol detox and programs that continue treatment afterward. When you call a program, ask specifically about medication for alcohol use disorder and about what happens in the first week after discharge. Call 800-996-6135(Sponsored) to learn more about your treatment options.