TOPLINE:

A fully integrated substance use disorders emergency department (SUD-ED) model achieved 33.2% of post-acute treatment engagement, with patient-initiated admissions showing 3.49-fold higher odds of engagement than ambulance-initiated admissions, highlighting the need for targeted interventions.

METHODOLOGY:

• Researchers conducted a retrospective cohort study analysing electronic health record data linked with five registries in Stockholm, Sweden.
• The analysis included 9771 patients who visited the SUD-ED from February 2018 to June 2019.
• Post-acute SUD treatment engagement was defined as two or more outpatient visits during a 6-month follow-up period, with four levels of engagement (none, low, moderate, and high) derived using a quantile regression approach.
• Investigators examined 19 candidate predictors through multinomial logistic regression models to identify factors associated with varying levels of treatment engagement.

TAKEAWAY:

• Patient-initiated admissions demonstrated significantly higher odds of high treatment engagement than ambulance-initiated admissions (adjusted odds ratio [aOR], 3.49; 95% CI, 2.60-4.68), whereas police-initiated admissions demonstrated lower odds of high treatment engagement than ambulance-initiated admissions (aOR, 0.71; 95% CI, 0.53-0.95).
• Prior needle and syringe programme visits were associated with increased odds of high treatment engagement (aOR, 2.09; 95% CI, 1.59-2.75).
• Patients with opioid use showed 3.57-fold higher odds of high treatment engagement than those with alcohol use (95% CI, 2.56-4.99).
• Treatment-naive individuals consistently showed lower odds of engagement across all levels, with particularly low odds for high engagement (aOR, 0.23; 95% CI, 0.19-0.28).

IN PRACTICE:

"In parallel to research on post-acute treatment engagement, a landscape of initiatives is emerging for expanding access to specialized SUD care in acute and hospital settings, from the moment of contact," the authors wrote.

"Aftercare options should, therefore, be broadened to better suit treatment-naive individuals, for example, by offering dedicated time slots for outpatient follow-up (next-weekday appointments) for individuals with greater SUD severity and low-cost, supplementary aftercare approaches, such as digital aftercare guides, to better reach individuals with no prior SUD-treatment experience," they added.

SOURCE:

This study was led by Danilo Romero, Karolinska Institutet, Stockholm, Sweden. It was published online on January 25, 2026, in Addiction.

LIMITATIONS:

The observational design precluded causal conclusions regarding the efficacy of the integrated model. The inclusion of patients requiring residential care in the outpatient treatment rate calculation may have underestimated the true rate of appropriate treatment engagement.

DISCLOSURES:

This research received funding from the Swedish Research Council for Health, Working Life and Welfare. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.