Every year, millions of hospital stays involve people who use alcohol or drugs. In some cases, drug or alcohol use is the immediate reason for their hospitalization; in other cases, substance use is one of multiple contributing medical causes
Whatever their principal diagnosis, patients with substance use disorders (SUDs) urgently need substance use care. However, research has found that hospitals infrequently provide effective treatments such as medications for opioid use disorder and alcohol use disorder. And hospital discharge practices seldom connect patients with SUDs to outpatient services, a gap in care that increases the risk of hospital readmission or even death
When hospitals provide appropriate care and connect patients to treatment in their communities after discharge, hospital readmissions and mortality decline. Hospitals that do not provide these services miss an opportunity to improve and save lives
To help public health leaders and policymakers improve care for people with SUDs, The Pew Charitable Trusts researched national- and state-level trends in hospitalizations associated with substance use. Using data from the Healthcare Cost and Utilization Project, an initiative of the federal Agency for Healthcare Research and Quality, Pew analyzed alcohol-, opioid-, and stimulant-associated hospital stays from 2016 to 2022. Key findings include:
- The number of alcohol-involved hospital stays reached an estimated 1.8 million in 2022, far outpacing those involving opioid and stimulant use and nearly reaching the estimated number of admissions involving COVID-19 (2 million) in the same year.
- Stimulant-related hospital stays are on the rise and were the second most common type of stay examined in 24 out of 40 states in 2022—up from eight out of 38 states in 2016.
- Approximately 1 in 5 opioid-related stays ended in a discharge against medical advice in 2022, with undertreated pain and withdrawal symptoms, stigma, and restrictive hospital policies likely to have contributed to these discharges.
Effective models for improving hospital-based addiction care
To meet the needs of people with SUDs, the American Society of Addiction Medicine (ASAM) recommends that all hospitals demonstrate core competencies for SUD care. These include identifying patients with an SUD; providing appropriate care, including withdrawal management; and connecting patients with ongoing care after discharge
ASAM outlines several models for delivering substance use care:
- Addiction consult service (ACS) teams—often composed of addiction medicine physicians, nurses, social workers, and peer navigators—assess substance use history and risk, determine appropriate treatment plans, and refer patients to lower levels of care when appropriate. Patients treated by ACS teams receive addiction medications at higher rates and are less likely to experience a 30-day hospital readmission or discharge against medical advice compared with patients not seen by ACS teams.
- Practice-based models integrate addiction care into regular practice, allowing generalists to serve patients with SUDs when a hospital lacks addiction specialists. These models can help ensure that patients with opioid use disorder and alcohol use disorder receive necessary medications, and they can decrease discharges against medical advice as well as readmissions.
- In-reach models, which rely on community-based or telemedicine addiction care to support hospitals that may lack the capacity to provide ACS teams or practice-based models, can support hospitals in identifying patients who use drugs and in initiating addiction care. Remote ACS teams also can help increase medication initiation and decrease hospital readmission rates.
- Bridge clinics support patients in transition from inpatient care to lower levels of treatment. Models vary—with some bridge clinics located on medical center campuses, others operating within existing outpatient facilities, and others providing remote services—but all aim to fill gaps in the addiction care continuum and to provide low-barrier, immediate access to treatment. Patients have reported positive experiences with bridge clinics, which have been shown to help reduce future hospitalizations and emergency department visits and improve
care continuity for patients with complex health needs.
These models can also lead to cost savings: One study found that an ACS team reduced hospital costs by $17,780 per patient over 12 months. Another study demonstrated a 10% reduction in a health plan’s total costs per member per month after a bridge clinic visit
What policymakers and hospital leaders can do
To help hospitals adopt these models, policymakers can direct time-limited funding options like opioid settlement funds and Rural Health Transformation Program grants to cover startup costs
Leaders in some states are already allocating opioid settlement funds to support recommended services. Massachusetts used $21.6 million to support addiction consult services and bridge clinics at 22 hospitals. A bridge clinic in the Alameda Health System in California receives $400,000 per year in funds from Alameda County. Florida appropriated $4 million for hospital bridge programs in fiscal year 2026
Funds from the Rural Health Transformation Program, a new federal grant effort designed to support state initiatives to improve healthcare quality in rural communities, also can help. Many states included substance use and behavioral health initiatives in their applications. Pennsylvania plans to fund a statewide telemedicine bridge clinic, and Rhode Island seeks to fund a bridge clinic and addiction consult services in four rural hospitals. States may be able to include these services
within a behavioral health initiative depending on their approved application with the Centers for Medicare & Medicaid Services.
With proper startup funding, hospital leaders can use newly released ASAM implementation guidance to select the most effective approach for their settings, as well as to develop strategies for building staff buy-in, educating providers, and planning workflows. The guidance also offers important insights about how to sustain these programs over time with billing systems and general funds
Rob Siebers is an associate I with The Pew Charitable Trusts’ substance use prevention and treatment initiative. Frances McGaffey formerly worked at Pew on the same initiative
