Substance Use Disorder Raises 30-Day Hospital Readmission Risk by 24%

Lets start with something real: If someone you care about has struggled with drugs or alcohol, you already know how heavy it feels when they end up back in the hospitalagain. Its not just frustrating; it can feel helpless. But heres what many dont realize: its not a personal failure. Its part of a pattern, one that science is finally helping us understand.

A recent UCLA-led study published in the journal Addiction found that people with a substance use disorder (SUD)whether its opioids, alcohol, stimulants, or anything elseare 24% more likely to be readmitted to the hospital within 30 days of discharge. Thats not a small number. And its even higher for those using multiple substances or dealing with mental health issues at the same time.

But heres the thingits not because people dont want to heal. Its because the care system often doesnt treat the real problem. We fix the broken bone, the infection, the overdose and then send someone home without addressing the underlying struggle with substance use. Its like patching a leaky roof during a storm and hoping it holds.

If this sounds familiar to youeither because youve experienced it or walked beside someone who hasyoure not alone. And this isnt a blame game. This is about understanding, compassion, and real solutions. So lets talk about why this happens, how it impacts lives, and most importantly, what can actually help.

Why It Happens

Imagine being in the ER because of an overdose. They stabilize you, monitor your vitals, maybe even talk about resources. But then youre dischargedno follow-up, no medication, no therapist appointment, no handoff to a treatment program. Now youre back in the same environment, same triggers, same painonly now, you might feel even more isolated.

Thats the gap. Hospitals are amazing at treating acute medical crises, but far too often, they stop short of treating the condition driving those crises: substance use disorder.

What the 24% Really Means

The 24% increased risk for 30-day unplanned readmission isnt just a number floating in the air. It comes from analyzing thousands of hospital stays, comparing patients with SUD to those withoutcontrolling for things like income, age, mental health, and other health conditions. Even with all those factors accounted for, SUD still stands out as a major risk.

And its not limited to one type of substance. The study showed the increased risk applied across the boardalcohol, opioids, stimulants, even cannabis. The more substances involved, the higher the risk. People using three or more had a 38% higher chance of returning within a month.

Key Findings from the Study

Factor	Increased Risk	Real-World Example
Any SUD diagnosis	24% higher readmission	A patient treated for pneumonia returns two weeks later after an opioid overdose
Poly-substance use	38% higher risk	Using alcohol and meth together increases medical complications and reduces treatment engagement
Co-occurring mental illness	+15% more risk	Depression makes it harder to follow up with care or stay motivated in recovery
No outpatient SUD follow-up	Nearly double the risk	45% of patients with SUD leave the hospital without a single behavioral health referral

Whats especially concerning is that nearly half of patients with substance use disorder leave the hospital with zero plan for ongoing support. No referrals. No prescriptions for medications that could help. Nothing. Is it any wonder they come back?

What Brings Them Back

You might think: "Cant they just stop?" But SUD isnt about willpower. Its a medical conditionone that affects brain chemistry, decision-making, and coping mechanisms. The complications that lead to readmission are often predictable, preventable, and painfully human.

Common SUD Complications

• Overdose Especially with opioids, even a short relapse can be deadly.
• Alcohol withdrawal Not just shakessevere cases can lead to seizures or delirium tremens.
• Infections From abscesses to endocarditis to hepatitis C, IV drug use carries serious risks.
• Mental health crises Untreated bipolar disorder, PTSD, or depression can spiral when mixed with substances.
• Worsened chronic conditions Think diabetes, liver disease, or heart issues that go unmanaged during periods of active use.

None of these happen in a vacuum. Theyre tied to the struggle of living with a disease that most healthcare systems still treat as a side note.

Real Stories Behind the Stats

Take John, 47, who was treated for sepsis from a leg infection. He got IV antibiotics, his fever dropped, and he was sent home with oral meds. But no one asked about his heroin use. No one offered buprenorphine. And when the pain returned, he used again. He missed doses. The infection came back stronger. Back to the hospitalless trusting, more discouraged.

Or Maria, 32, who was admitted with pancreatitis linked to heavy drinking. She improved in the hospital, but no one connected her with detox or counseling. Ten days later, she experienced severe alcohol withdrawalhallucinations, confusion, tremorsand ended up back in the ER. Scary? Absolutely. Preventable? Yes.

These stories arent rare. Theyre the norm in a system that treats symptoms but not causes.

What SUD Really Is

Lets clear something up: Substance use disorder is not a moral failing. Its not laziness. Its not a character flaw. Its a medical conditionrecognized by major health institutions like the Mayo Clinic, the American Psychiatric Association, and the NIHthat changes how your brain works.

When someone has SUD, their brains reward system gets rewired. Substances flood the brain with dopamine, teaching it that using is more important than eating, sleeping, or staying safe. Over time, the brain cant feel pleasure from normal activities. Stopping doesnt just feel hardit can feel impossible.

How Do You Know If Its SUD?

The DSM-5-TR (the diagnostic manual used by clinicians) outlines several signs. You dont have to have them all, but if two or more apply over a 12-month period, it could mean SUD:

• Cravings so intense they drown out everything else
• Using more or longer than intended
• Repeated attempts to cut down or quitbut failing
• Spending a lot of time getting, using, or recovering from the substance
• Skipping work, school, or family events because of use
• Continuing to use even when its causing health or relationship problems
• Needing more of the substance to get the same effect (tolerance)
• Feeling physically sick when you stop (withdrawal)

Mild? Two or three symptoms. Moderate? Four or five. Severe? Six or more. But heres the thing: you dont need a diagnosis to deserve help. You just need to be struggling.

What Causes SUD?

Theres no single path into SUD. For some, it starts with a prescription after surgery. For others, its a way to numb trauma, manage anxiety, or escape poverty. The common thread? Its almost never about "party culture."

Research from NIDA shows its a mix:

• Brain chemistry Drugs hijack natural reward pathways.
• Genetics 3060% of risk is hereditary.
• Trauma Adverse childhood experiences (ACEs) dramatically increase risk.
• Mental health About half of people with SUD also live with depression, PTSD, or bipolar disorder according to the National Institute of Mental Health.
• Environment Where you live, who youre around, and what youve been through all shape your risk.

The Double Burden

Have you ever heard someone say they "drink to numb the pain"? Thats not just a phrase. Its real. Many people use substances to cope with emotional paingrief, anxiety, past abuse, loneliness. We call this "self-medicating," but its really just survival.

How Common Is It?

Very. According to the NIMH, over half of people with substance use disorder also have a diagnosable mental illness. The most common pairings? Depression and alcohol, PTSD and opioids, anxiety and benzodiazepines.

And it goes both ways: chronic substance use can make mental health worse. Stimulants can trigger psychosis. Alcohol can deepen depression. It becomes a loopuse to feel better, feel worse, use more.

Why Treating Both Matters

Imagine treating a diabetics high blood sugar but ignoring their insulin deficiency. Thats what happens when a hospital treats the infection from injection drug use but ignores the depression or trauma behind it.

People dont heal in pieces. They heal when the whole picture is seen and supported. Thats why integrated treatmentwhere mental health and SUD care happen togetherhas been shown to reduce hospital readmissions, improve engagement, and save lives.

What Integrated Care Looks Like

• Therapy Cognitive Behavioral Therapy (CBT), motivational interviewing, trauma-informed care.
• Medications Buprenorphine for opioid use, naltrexone for alcohol, SSRIs for depression.
• Peer support Programs like Narcotics Anonymous or SMART Recovery offer connection without judgment.
• Family involvement Because healing affects everyone.

In fact, UCLA researchers found that patients with co-occurring disorders who got no integrated plan were 2.3 times more likely to be readmitted within 30 days.

What Actually Helps

Heres the good news: recovery is possible. The cycle of unplanned readmission can be broken. But it takes more than willpower. It takes systems that care.

Proven Ways to Reduce Readmissions

1. Start Medication-Assisted Treatment (MAT) in the hospital Studies show that when patients get buprenorphine or naltrexone before discharge, theyre more likely to stay in treatment, less likely to relapse, and far less likely to return to the ER.
2. Universal SUD screening at admission Just like checking blood pressure, every patient should be screened. Many hospitals still dont do this, but its changing.
3. Discharge planning with SUD specialists Not just a pamphlet. A real plan. Connections to treatment, housing, transportation, peer support.
4. 24-hour warm handoffs This means staff literally call the treatment center and say, "Were sending someone over today." No gaps. No "figure it out later."
5. Harm reduction support Naloxone kits, syringe services, fentanyl test strips. These dont encourage usethey keep people alive so they can get help.

Whos Getting It Right?

Some hospitals are leading the way. At Massachusetts General Hospital, addiction specialists now work directly in the ER and inpatient units. At UPenn Health, theyve automated SUD screening and can start MAT within hours of admission. In Oregon, state-funded peer navigators help patients move smoothly into outpatient care.

The result? Some sites have reduced 30-day SUD readmissions by up to 30%. Thats real progress. And it starts with seeing people as whole humansnot just a diagnosis.

How to Support Someone

If youre sitting there thinking, "That could be my brother," or "Thats my daughter," I see you. Loving someone with SUD is hard. Its exhausting. You want to fix it, but you cant. And guilt? It sneaks in from every side.

What Not to Do

Youve probably heard advice like "tough love works" or "they need to hit rock bottom." But research and experience say otherwise. Heres what usually backfires:

• Shaming or lecturing It deepens shame, which fuels use.
• Making excuses "Theyre stressed" or "Theyve had a rough year" may be true, but it delays real help.
• Confronting during intoxication They cant hear you, and it damages trust.
• Using with them It doesnt build connectionit enables.

What to Do Instead

• Learn Read about SUD from trusted sources like SAMHSA or the Mayo Clinic. Knowledge is power.
• Talk with care "Ive noticed youve been missing work. Im worried. Can we talk?"
• Listen Not to fix, just to hear. Sometimes thats everything.
• Offer support "Ill drive you to the first appointment. Ill wait in the car."
• Encourage treatment Not because theyre broken, but because theyre loved.

And pleasetake care of yourself. Support groups like Al-Anon and Nar-Anon arent just for "families of addicts." Theyre for anyone who loves someone in the storm.

Where to Start

If youre wondering where to go from here, start here: Youre not alone. Help exists. And recovery is possible.

Free Resources You Can Use Today

Service	Contact	What They Offer
SAMHSA National Helpline	1-800-662-HELP (4357)	Free, confidential, 24/7 support. Treatment referrals in English and Spanish.
Narcotics Anonymous	na.org	Worldwide peer-led recovery meetings.
Alcoholics Anonymous	aa.org	In-person and virtual meetings for anyone struggling with alcohol.
SMART Recovery	smartrecovery.org	Science-based, non-12-step support programs.
Crisis Text Line	Text "HOME" to 741741	Immediate, anonymous support for emotional distress.

And if you're a family member, don't forget: healing is for you, too. Al-Anon and Nar-Anon offer free meetings and community. You dont have to carry this alone.

Final Thoughts

The 24% stat? Its not a verdict on people with substance use disorder. Its a mirror held up to our healthcare system. And while the number is sobering, its also a call to do better.

Better screening. Better treatment. Better compassion. Better integration of mental and physical health care.

Recovery isnt a straight line. Its messy. Its full of starts and stops. But with the right support, people do get better. They return to work. They rebuild relationships. They find joy again.

If you or someone you love is walking this pathdont wait for the next crisis. Take that first step. Call the helpline. Send the text. Show up to the meeting. Healing begins not when everything is fixed, but when someone decides theyre worth fighting for.

And they are.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.