Subgroup analyses by baseline alcohol consumption of 3-year psychotropic and opioid use and healthcare utilization in patients treated for depression

This three-year follow-up study on secondary subgroups embedded in a Swedish randomized controlled trial, Regassa, investigated whether hazardous alcohol consumption influences health care utilization and use of psychotropics and opioids among patients with depression who received treatment for depression but no intervention targeting alcohol use. The cohort of 929 patients was divided into patients reporting hazardous and patients reporting non-hazardous alcohol consumption. Three-year follow-up, registry data on primary and specialized care utilization, as well as dispensed psychotropic and opioid medication were added.

Differences in prevalence between the groups were analysed using Prevalence Proportion Ratios and differences in the number of consultations were analyzed using Poisson regression. Medication dispenses and defined daily doses (DDD) were analyzed with a two-step model (1) logistic regression presented as odds ratios (OR) (2) negative binomial regression, presented as incidence rate ratios (IRR). Most participants were women and hazardous alcohol use was reported by 22%, predominantly men.

Patients reporting hazardous consumption seemed more likely to be prescribed psychotropics despite fewer health care visits, but among users there were no differences between the groups regarding the amount of medication. Over time, there was a tendency they had lower levels of prescribed opioids and less visits for pain diagnosis. Patients with hazardous alcohol consumption and concurrent depression seem to be prescribed psychotropics more often.

These findings may be relevant for clinicians in health care settings when assessing patients with depression to also screen for alcohol consumption and pain and offer tailored and effective interventions. Hazardous alcohol consumption without having an alcohol use disorder is associated with a risk of adverse health outcomes, encompassing not only increased vulnerability to injuries and somatic diseases but also an increased risk of developing an alcohol use disorder and other mental health disorders1,2. Empirical evidence demonstrates a significant bi-directional correlation between hazardous alcohol use and depression3,4,5,6,7,8.

Patients having depression and concomitant hazardous alcohol consumption exhibit an elevated risk for a negative development where the consequences have not yet emerged9,10. The comorbidity between alcohol use and depression is not unique; rather, comorbidity between different mental health problems and substance use disorders is common in clinical practice11. Nevertheless, the observed association between alcohol use and depression may comprise treatment efficacy12 and may also affect healthcare utilization13.

The clinical picture is further exacerbated in patients experiencing concurrent chronic pain14. This study was conducted in the Swedish primary health care where a large proportion of patients with anxiety, depression, problematic alcohol use, and pain are treated15. All included participants were screened with the Alcohol Use Disorder Identification Test, AUDIT developed by Babor and colleagues (2001) to help practitioners in Primary care to detect patients` level of alcohol consumption and identify hazardous drinking, harmful alcohol use or alcohol dependence16.