(PO-065) (PO-065) High-utilization, hospitalized patients with alcohol use disorder: initial RCT participant characteristics and correlations

Background/Significance:
Alcohol use disorder (AUD) impacts 15 million Americans leading to 5 million annual emergency department (ED) visits and 2 million admissions (White et al., 2018). Hospitalization is a vital opportunity to intervene, and two pharmacologic interventions given before discharge may be effective at reducing re-admissions. Little is known about the AUD population willing and able to be randomized in this setting.

Methods:
Our open-label, pilot trial (target n=45-60) randomizes participants to 1) extended-release naltrexone injection, 2) intravenous ketamine infusion, or 3) enhanced-linkage alone. Adult, hospitalized participants with severe AUD and at least one past-year admission are recruited through addiction consultation at an urban, safety-net hospital. Demographics, adverse childhood experiences (ACE), Timeline Follow Back drinking history (TLFB), and depressive symptoms (PHQ-9) are recorded at baseline. For this abstract, we present participant characteristics and explore correlations (Pearson r coefficient) between multiple scales of interest and hospital utilization. IRB approval obtained.

Results:
Among 32 complete participants, demographics are: mean age 45, 75% male, 56.25% Caucasian, 34.4% not stably housed. They on average had 13 past-year ED visits, with 5 hospitalizations. Clinical characteristic means are: 12.14 daily drinks, PHQ-9 score 13.2 (of 27), ACE score 4.16 (of 10), and DSM5 criteria total 9.5 (of 11) for AUD. Daily drinks was significantly correlated with hospitalizations (r = 0.517, p=0.0029) as well as ED visits (r = 0.372, p=0.039). ED utilization was also significantly higher for homeless/unstably housed individuals vs stably housed individuals (t(28)= 4.025, p=0.00039).
 

Discussion:
This safety-net hospital, AUD-research population is high acuity regarding addiction/psychiatric state, housing status, and hospital utilization. Modest correlations observed between daily drinks and depression symptoms with acute care utilization, respectively, are limited by sample size. This population differs from other studies involving ketamine and naltrexone for AUD. For example, in Dakwar et al. (2019), ketamine participants consumed 6.6 daily drinks and had minimal depressive symptoms. In Bryson et al. (2011), XR naltrexone patients had 0.75 ED visits per half-year.

Conclusion:
Trial recruitment appears feasible among a unique, high-utilization sample of hospitalized patients with AUD. Trial results may expand the inpatient toolkit of treatments for this pervasive disease.

Bryson WC, McConnell KJ, Korthuis PT, et al (2011). Extended-Release Naltrexone for Alcohol Dependence: Persistence and Healthcare Costs and Utilization. The American Journal of Managed Care, 17(Suppl 8), S222–S234.

Dakwar E, Levin F, Hart C, et al (2019). A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial. The American Journal of Psychiatry, appiajp201919070684.

White AM, Slater ME, Ng G, Hingson R, et al (2018). Trends in Alcohol-Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcoholism: Clinical and Experimental Research, 42(2), 352–359.