Alcohol and Mental Health Problems a Costly Combo for ICU Patients

KEY POINTS

* A co-existing mental condition raises the risk of hospital readmission or death for patients admitted to the ICU with alcohol withdrawal.* Interventions to help address mental health conditions and offer support for alcohol dependence could reduce re-hospitalization.

People admitted to a hospital intensive care unit (ICU) with alcohol withdrawal were more likely to be readmitted or die within a year of their first hospitalization if they had a co-existing mental health condition such as depression, anxiety or schizophrenia, finds a recent study in Alcoholism: Clinical and Experimental Research.

“On average, every single day we have a patient with alcohol withdrawal that is sick enough to warrant treatment in an intensive care unit,” said Brendan J. Clark, MD, lead author of the study. “Ninety-seven percent of the patients survived their initial hospitalization, but 44 percent were readmitted to the hospital within a year or died,” he said.

Rates of re-hospitalization for patients suffering from alcohol withdrawal with one psychiatric illness were 66 percent. For those with two or more mental conditions, the rate was 78 percent.

In general, disease-based strategies help reduce costly hospital readmissions. For example, when patients visit an ICU with asthma symptoms, doctors often prescribe inhaled corticosteroids to control the condition and prevent future emergency room visits, note the researchers. Developing effective strategies that address co-existing mental health conditions for patients admitted with alcohol-related problems could help reduce readmissions, as such conditions are associated with a poor response to alcoholism treatment, say the authors.

“Currently, there is no systematic approach to identifying and helping patients with alcohol-related problems,” said Clark. “Current systems vary from hospital to hospital, and while some systems may do a good job of offering help to some patients, our goal should be to deliver effective care to every patient who needs it.”

Being admitted to the ICU can motivate patients to quit drinking, but there is often no system in place to help patients maintain that motivation.

According to Krista Roybal, M.D., medical director at the Scripps Drug and Alcohol Treatment Program, an effective strategy might be to treat the whole person and all of his or her co-existing medical problems.

“I’d love to see all patients who are admitted to the hospital with alcohol dependence [get] a psychiatric assessment that includes motivational interviewing. My objective with this would be to increase the linkage from inpatient to outpatient treatment for alcohol dependence,” she said.

One way this might be accomplished is with intervention teams.“Intervention teams, working in conjunction with family or the supportive system of the ICU patient, may be able to facilitate direct transition from the hospital into a treatment setting or safe environment for follow-up care on an outpatient basis,” said Terry Schneekloth, M.D., a psychiatrist specializing in addiction at the Mayo Clinic. “Patients with alcoholism severe enough to require ICU admission are likely to struggle with strong cravings to resume drinking post-hospitalization without significant professional support.”

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Alcoholism: Clinical and Experimental Research: Contact Mary Newcomb at (317) 375-0819 or [email protected] or visit: http://onlinelibrary.wiley.com

Clark, Brendan J; Keniston, Angela; Douglas, Ivor S; Beresford, Thomas; Macht, Madison; Williams, Andre; Jones, Jacqueline; Burnham, Ellen L; Moss, Marc. (2013) Healthcare Utilization in Medical Intensive Care Unit Survivors with Alcohol Withdrawal. Alcoholism: Clinical and Experimental Research, Winter 2013