Relationships of patient risk profiles and receipt of specialty treatment with early, sustained, and stable cessation of heavy alcohol use across populations.

BACKGROUND

Identifying individual-level factors that predict cessation of heavy alcohol use would inform the prevention, intervention, and treatment of heavy alcohol use. This study examined whether and how patient risk profiles and specialty treatment predict early, sustained, and stable cessation of heavy alcohol use, and whether there are differences by patient characteristics.

METHODS

This electronic health records-based cohort study included 128,471 adults with heavy alcohol use (exceeded national daily or weekly drinking limits) in an integrated healthcare system between 6/1/2013 and 12/31/2014. Cessation of heavy alcohol use was examined over 1-year (early), 5-year (sustained), and 7-year follow-ups (stable), through 6/30/2022. Latent class analysis identified five patient risk profiles differentiated by type of heavy alcohol use and levels of health risk behaviors and comorbidities. Associations of risk profiles, specialty addiction or psychiatry treatment, race and ethnicity with cessation outcomes were examined with logistic regression.

RESULTS

Approximately 65.8 % of the sample had early cessation at 1-year. Compared with patients in the heavy daily drinking and fewer health risks profile (DAILY), patients in the heavy daily drinking and more health risks profile (DAILY-R) had higher odds of early cessation (aOR [95 % CI] = 1.28 [1.23, 1.33]), while patients in risk profiles with heavy weekly drinking and substance use and mental health disorders had lower odds of early cessation (aORs = 0.40 to 0.77). Specialty treatment (versus no treatment) was associated with higher odds of early cessation (1.27 [1.18, 1.35]), which varied by risk profile. Hispanic/Latino patients in the DAILY-R profile had lower odds of early cessation than their White counterparts (0.84 [0.76, 0.91]). At 5 and 7 years, 60.7 % and 88.0 % had sustained and stable cessation after achieving the prior cessation status, respectively. Results of sustained and stable cessation were largely consistent with those of early cessation, but interactions with race and ethnicity were non-significant.

CONCLUSIONS

Specialty treatment may be effective for most types of patients with varying levels of health risks, across populations. Findings suggest that Hispanic/Latino patients with heavy daily drinking and more health risks may need tailored interventions in primary care to support cessation of heavy alcohol use.