Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use

Jananie Ramesh; Christopher Moriates; John Embers; Alanna Boulton; Nicole Kluz; Rachel Holliman; Frances Ibarra; Ohenewaa Dede-Bamfo; Patrick Chang; Mary Velasquez; Michael Pignone

doi:10.1007/s11606-026-10473-9

Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use

J Gen Intern Med. 2026 May 14. doi: 10.1007/s11606-026-10473-9. Online ahead of print.

Authors

Jananie Ramesh¹, Christopher Moriates^{2

3}, John Embers^{4

5

6}, Alanna Boulton^{4

6}, Nicole Kluz^{4

7}, Rachel Holliman⁴, Frances Ibarra⁴, Ohenewaa Dede-Bamfo⁴, Patrick Chang⁷, Mary Velasquez⁸, Michael Pignone^{7

9}

Affiliations

¹ Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX, USA. jananie.ramesh@austin.utexas.edu.
² Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
³ Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁴ Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX, USA.
⁵ CommUnity Care Health Centers, Austin, TX, USA.
⁶ Central Health, Travis County Health District, Austin, TX, USA.
⁷ Department of Population Health, Dell Medical School at The University of Texas at Austin, Austin, TX, USA.
⁸ The University of Texas at Austin, Steve Hicks School of Social Work, Austin, TX, USA.
⁹ Department of Medicine, Duke University, Durham, NC, USA.

PMID: 42135584
DOI: 10.1007/s11606-026-10473-9

Abstract

Background: Screening and treatment for unhealthy alcohol use (UAU) and alcohol use disorder (AUD) are recommended but underutilized, particularly in hospital settings.

Objective: To determine whether a comprehensive screening and treatment protocol for UAU in hospitalized patients can help reduce alcohol use.

Design: Quality improvement study at single-center safety-net hospital.

Participants: 27,914 patients were admitted from 9/2022 to 9/2024, and 18,146 (65.0%) were screened with AUDIT-PC, with 1085 (6.0%) screening positive (≥ 5). Substance use navigators (SUNs) identified 257 additional patients with UAU through referral methods.

Intervention: SUNs approached eligible patients and conducted full AUDIT and brief behavioral counseling. Patients with AUDIT ≥ 12 were offered medications for AUD (MAUD) during hospitalization and at discharge.

Main measures: Intervention delivery, 30-day return hospital encounters (readmission or emergency department), and change in AUDIT score among high-risk patients.

Key results: Of the 1342 intervention-eligible patients, 81% were men, and the mean age was 51 years. 54% were Caucasian, 30% Hispanic/Latinx, and 9% Black. 17% were unhoused, and 18% were uninsured. Of these 1342, 800 (59.6%) patients engaged in the intervention. The mean AUDIT score was 15 (median 14, IQR 8-21). For the 489 (61.1%) patients with AUDIT ≥ 12, 231 (47.2%) were started on medication before discharge. For the 126 patients with repeat AUDIT (25.8%), the mean reduction was 14.2 points (95% CI: -15.4, -12.2). For those with AUDIT ≥ 12, 128 (26.2%) patients had a return hospital encounter within 30 days of discharge. Patients without return encounters had significantly larger reductions in AUDIT score than those who had return encounters (mean reduction -16.2 vs -9.1 points (difference -7.1, 95% CI: -3.1, -11.0)).

Conclusions: UAU screening and risk-stratified treatment (including pharmacotherapy) can be delivered in diverse hospitalized patients, and were accompanied by short-term changes in alcohol risk score among patients reached for follow-up.

Keywords: alcohol use; brief intervention; hospital medicine; quality improvement.