People who seek treatment for an injury in the emergency department and are intoxicated or have an alcohol use disorder are five times more likely to die in the next year than people in the general population, according to new research that analyzed more than 10 million California ER visits.
“For every 100 injured patients who were intoxicated or had alcohol use disorder who came to the emergency department, 5 of them died within the next year, versus 1 out of 100 in the comparison population. That’s a big difference,” says the lead researcher, Sidra Goldman-Mellor, PhD, MPH, an assistant professor in the department of public health at the University of California in Merced. The findings were published on December 12 in the Journal of Studies on Alcohol and Drugs.
“These findings are particularly concerning because we know alcohol misuse has increased in the past few years, especially since the pandemic,” says Sarah Andrews, MD, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore. Dr. Andrews, a specialist in alcohol dependency, was not involved in the new study.
Deaths Involving Alcohol Jumped 25 Percent in the First Year of the Pandemic
According to the 2019 U.S. National Survey on Drug Use and Health, an estimated 14.5 million Americans ages 12 and older have AUD.
Since about 2000, alcohol-related deaths have been increasing about 2.2 percent each year. But the number of people with AUD jumped 25.5 percent from 2019 to 2020 (the first year of the pandemic), for a total of about 99,000, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Alcohol use disorder (AUD), sometimes called alcoholism, is considered a medical condition. People with AUD drink heavily or frequently and can’t stop, even when their behavior negatively impacts their relationships, work life, and health, according to the NIAAA.
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AUD is considered a brain disorder and can be mild, moderate, or severe. Because lasting changes in the brain caused by alcohol misuse perpetuate the condition, individuals are vulnerable to relapse.
Alcohol Use Raises the Risk of Many Different Types of Injuries
The rise of problematic drinking and its potential health consequences are part of what led Dr. Goldman-Mellor and her team to conduct this study.
Although the average person might not see the immediate connection between alcohol use and getting hurt, injuries are actually one of the most immediate hazards of problematic drinking behavior. “If you think about it, car accidents, falls, fights, and even self-harm — these are all more likely if a person is intoxicated,” says Goldman-Mellor.
But little is known about what happens to people with an alcohol use disorder after they’ve had a serious injury, she says. “We wanted to investigate the most important outcome of all: how likely they were to die.”
5 of Every 100 Injured ER Patients Who Were Intoxicated or Had Alcohol Use Disorder Died Within a Year
Researchers used data from all the emergency department visits by California residents age 10 and older from 2009 to 2012, a total of more than 10 million visits. Within that group, they identified 262,222 people who had a nonfatal injury and either had a diagnosis of an alcohol use disorder or were intoxicated at the time of the injury.
The majority of these injuries, about 77 percent, were coded as unintentional. An additional 13 percent were caused by assault, 8 percent were reported as self-harm, and 2 percent were due to unknown causes.
Within 12 months of their hospital visit, 13,175 people (about 5 percent) had died — a total mortality rate of nearly 5,205 per 100,000. Calculations revealed that figure is more than five times the death rate for the rest of the California population, after matching for age, gender, race, and ethnicity — all strong determinants of mortality risk.
“We were surprised at how large of an increase in mortality that these injured patients who had a documented alcohol use disorder were facing. Alcohol-related health injuries are a public health problem, but now we also know that the people who are getting care for those injuries are at a much higher risk of dying over the next year,” she says.
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Chronic Diseases and Alcohol Misuse Likely Contributed to Higher Death Rate
Investigators were not able to examine what happened to the patients after hospital discharge, but they suspect many of them were already very ill when they initially came to the ER, and their health declined further after that.
“Many of these patients clearly must have had some type of chronic disease or long-running health problems that no doubt contributed to their deaths, and possibly their alcohol misuse contributed again,” says Goldman-Mellor.
Healthcare providers who are caring for these people should be aware of their high risk of death and take that into account when connecting these patients with ongoing services, whether that’s follow-up on their other medical conditions or substance abuse care, she says.
Fewer Than 1 in 10 People Who Misuse Alcohol Get Treatment
“Most people who struggle with alcohol misuse don’t get the help they need,” says Goldman-Mellor. According to the NIAAA, less than 10 percent of people with past-year alcohol use disorder receive any treatment.
“A lot of the time nobody outside their immediate circle has any awareness that the person is misusing alcohol. They may not talk about it with their doctor or anyone else. The person might not even realize their alcohol use is a problem,” she says.
Alcohol Misuse Needs to Be Identified and Discussed in ER
Even though it can be very busy and even chaotic at times, it’s realistic that alcohol misuse could be addressed in the emergency department, says Andrews. “Because this is a crisis, I do think there should be more effort to reach these people where they are and try to offer assistance. In many cases, that ER visit might be the only provider that they see in the next several months or more, and so I think there is an obligation to help,” she says.
In the last decade, many (but not all) ERs have hired trained professionals who can conduct a brief intervention and help connect people with treatment when they leave, says Andrews.
Providers should ask about alcohol use in every visit to the ER and address it when appropriate, she says. “Patients might not be ready to seek treatment at that point, but we can at least start the conversation and let them know what resources are available and how to access them when they are ready.”
Emergency departments can also connect people with regular primary care for chronic conditions such as heart disease, diabetes, and liver disease, says Goldman-Mellor. “Hopefully studies like ours can be used to increase resources for getting all such patients connected with comprehensive care, both for their substance use and general health,” she says.
The Health Risks of Excessive Drinking
The 2020–2025 Dietary Guidelines for Americans recommends that adult men limit intake to two drinks or less in a day and that women have one drink or less a day. What, exactly, is “one drink”? In the United States, a standard drink contains .6 ounces or 1.2 tablespoons of pure alcohol. That’s the amount typically found in a 12 ounce beer with 5 percent alcohol content, a 5 ounce glass of wine with 12 percent alcohol content, or a mixed drink with 1.5 ounces of 80 proof liquor (such as vodka, tequila, or whiskey).
In health terms, excessive drinking includes binge drinking and heavy drinking. Binge drinking is when you consume more than 4 (for women) or 5 (for men) drinks at a single occasion, and heavy drinking is defined as 8 or more drinks per week for women, and 15 or more drinks per week for men. Excessive drinking doesn’t necessarily mean you are abusing alcohol.
Most people who drink excessively are not alcoholics or alcohol dependent, per the Centers for Disease Control and Prevention (CDC).
But there are long-term health risks from drinking too much alcohol, including high blood pressure, heart disease, liver disease, digestive problems, certain types of cancer, dementia, and a weakening of the immune system, the agency says.