Relationships of Substance Use Disorders With Discharge Outcomes After Inpatient Rehabilitation: A Retrospective Cohort Study.

OBJECTIVE

To determine the prevalence of substance use disorders (SUDs) in patients with stroke, acquired brain injury (ABI), and other conditions; compare patient demographic and clinical characteristics by SUD status; and determine how SUDs are related to discharge disposition after inpatient rehabilitation for stroke, ABI, or other conditions.

DESIGN

Retrospective cohort study.

SETTING

Single inpatient rehabilitation facility.

PARTICIPANTS

A total of 8235 patients with stroke (n=2609), ABI (n=874), or other conditions (n=4752) discharged from an inpatient rehabilitation facility between April 2020 and April 2025.

INTERVENTIONS: NA.

MAIN OUTCOME MEASURE: Discharge disposition.

RESULTS

Patient history and physical examinations, conducted at the inpatient rehabilitation facility and preceding acute-care facilities, identified 18.7% of patients as having an SUD, with the highest prevalence in patients admitted for stroke and ABI (24% each). Nicotine use disorders (NUDs) were most common (15%), particularly in patients with stroke (21%). Alcohol use disorders (AUDs) were documented in 5.5% of patients overall, with the highest prevalence in patients with ABI (9.8%). In adjusted models, SUDs were associated with a reduced odds of home discharge, independent of rehabilitation diagnosis (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.60-0.87, P<.001). Interaction analyses found that the relationships between SUDs and home discharge were most pronounced in patients with ABI (OR: 0.48, 95% CI: 0.28-0.81, P=.006). NUDs, AUDs, and other SUDs were each associated with lower odds of home discharge overall (OR: 0.72, 0.60, 059, respectively). A significant interaction between AUDs and patients with ABI was observed (OR: 23, 95% CI: 0.10-0.50, P<.001).

CONCLUSIONS

SUDs were associated with reduced odds of home discharge after inpatient rehabilitation. Patients with AUD and ABI were disproportionately affected, highlighting the need for tailored discharge planning, extended institutional support, and caregiver assistance for patients with these co-occurring conditions.