Weber, Andrea N.

Abstract Aims Alcohol-associated liver disease (ALD) and alcohol use disorder (AUD) are interconnected and highly prevalent. Integrating substance use disorder (SUD) treatment into medical clinics may increase access to specialized care and improve liver-related outcomes. Methods A scoping review and quantitative analysis were completed on published literature before 4 September 2024. Included articles described SUD treatment integrated in medical settings for adults with liver disease and alcohol use. Specific focus in the analysis was placed on integrations that utilized telehealth formats, facilitated access to medications for AUD (MAUD), and intervened in liver transplant populations. Results Twenty-three full-length manuscripts and 10 conference abstracts met the inclusion criteria. Fourteen articles discussed MAUD access in ALD populations. Nine utilized telehealth interventions, and 12 focused on pre- and post-liver transplant populations considered high-risk for returning to alcohol use. Nine full-length manuscripts were included in a quantitative analysis, which showed a 9.7% risk difference (95% CI: 5.9–13.4) in any alcohol use, favoring integrated care over treatment as usual. Conclusions Integrated care for AUD and concurrent ALD populations can effectively reduce returns to alcohol use and be successfully integrated in a medical setting. The core ingredient of such interventions was the inclusion of an addiction medicine specialist into a medical setting, rather than an outside referral. Strategic telehealth utilization can further reduce geographic and specialty-specific barriers to SUD care in medically ill populations. More consensus is needed on key components, processes, and optimal outcomes for such integrated programs for people with concurrent liver disease and AUD.

AbstractBackgroundWorkforce engagement can provide structure, income, feelings of accomplishment, and personal contacts, growing an individual's recovery capital (RC). Employed individuals are also more likely to complete addiction treatment. We sought to investigate whether changes in employment status from alcohol treatment admission to discharge correlated with changes in alcohol use frequency over those time points.MethodsThe Treatment Episode Dataset—Discharges (2017–2021) provided the data. Employment status (full‐time, part‐time, unemployed, and not in labor force) and alcohol use frequency (daily use, some use, and no use in past month) were assessed at treatment admission and discharge. Changes in alcohol use frequency during treatment were recorded as Reduction or No reduction. Logistic regression using reduced alcohol use frequency as the dependent variable included employment status at admission and discharge separately. A second analysis included employment status at both admission and discharge and their interaction term. An adjusted model included all covariates (race, ethnicity, age, education, and referral source), with its results being used to derive the marginal probabilities of reduced alcohol use frequency.ResultsThere were 856,085 alcohol treatment admissions over the 5 years, with 221,724 (25.9%) first admissions. Transitioning from not in the labor force or unemployed to full‐time saw the largest percentage of encounters decreasing alcohol use frequency: 71.9% (95% CI: 70.0–73.7) and 69.3% (95% CI: 68.1–70.5), respectively. Those remaining unemployed had the lowest reduction at 26.7% (95% CI: 26.3–27.1), with a sample reduction of 42.7% (95% CI: 42.5–42.9) overall. Far more people (60.4%) completed treatment within the Reduction group than in the No reduction group (30.2%).ConclusionsFindings suggest that improving employment status may be relevant for reducing alcohol use frequency. This aligns with past work showing overall improved health outcomes with lower unemployment levels. Incorporating vocational training and workforce engagement activities into outpatient treatment may help augment traditional approaches to improve an individual's RC.

AbstractBackground and ObjectivesCriminal‐legal (CL) referrals to addiction treatment have historically had low utilization of medications for opioid use disorder (MOUD). While state differences have been reported, an in‐depth longitudinal analysis of state‐by‐state differences is lacking.MethodsThe Substance Abuse and Mental Health Services Administration Treatment Episode Dataset‐Admissions 2000–2020 provided data for individuals entering their initial treatment with an opioid as their primary substance. Outcome was planned use of MOUD, assessing odds ratio (OR) of CL referrals relative to non‐CL referrals cumulatively over the 21‐year period and as incremental change (change in relative disparity) using effect sizes, stratified by each state.Results2,187,447 cases met the criteria. Planned MOUD occurred in 37.7% of non‐CL clients versus 6.5% of CL clients (OR = 0.11, 95% confidence interval = 0.11–0.12). For all clients, planned MOUD increased from 2000 (33.9%) to 2020 (44.8%). This increase was blunted within CL clients, increasing from 2000 (6.4%) to 2020 (13.3%). Rhode Island saw the greatest improvements in equity.Discussion and ConclusionsWhile rates of planned MOUD increased over the 21 years, a significant disparity persisted among CL clients in most states. As opioid use disorders and opioid‐related overdoses are more prevalent among those involved with the CL system, improving this has high impact.Scientific SignificanceProvides the most comprehensive analysis of state‐by‐state inequities in MOUD access for CL relative to non‐CL referrals over a 21‐year period through use of a national data set. Positive outliers are used as case examples for others to follow in pursuit of more equitable care.