Alcohol-Related Emergency Department Utilization: A Systematic Review of Trends, Determinants, and Interventions

Background: Alcohol use contributes to morbidity‚ mortality and healthcare utilization․ Emergency departments (EDs) are often the first point of contact for alcoholrelated problems‚ including intoxication‚ injuries and chronic alcohol use complications․ While the literature on healthcare utilization related to alcohol is substantial and growing‚ to date‚ there has been no thorough‚ up-to-date overview of evidence from the ED perspective on trends‚ determinants‚ aetiology‚ economic burden and impact of interventions․ Methods: This systematic review was performed following the PRISMA 2020 guideline․ PubMed‚ MEDLINE (Ovid)‚ Embase‚ CINAHL and Google Scholar were searched․ Grey literature was also sourced from the World Health Organization and Agency for Healthcare Research and Quality․ Eligible studies published from January 2007 to March 2025 were quantitative epidemiological studies on alcohol-related ED presentations reporting on prevalence‚ trends‚ sociodemographic and socioeconomic factors‚ costs‚ or interventions․ Two reviewers independently screened studies for eligibility at the abstract and full-text level‚ with discrepancies resolved through consensus between the reviewers․ Study quality was assessed using the Newcastle-Ottawa Scale․ Given the heterogeneity between studies in terms of design‚ population‚ and outcomes‚ a narrative synthesis was used․ Results: Thirty-eight studies met inclusion criteria․ Presentation to the ED for alcohol use disordered ranged between 10 and 40% in different healthcare settings․ Most jurisdictions‚ especially in high-income countries‚ experienced an upward time trend in alcohol-related ED visits․ Demographic variables (sex and age) of affected populations were stable (predominantly males and younger adults‚ apart from older adults in new evidence in high-income countries)․ Socioeconomic disadvantage (especially income and geographic inequities) was a strong and consistent predictor of ED visits‚ consistent with the alcohol harm paradox․ Several included studies described racial or ethnic inequities․ The economic evidence was based on substantial and increasing economic impact‚ with national costs for both high-income and low- and middle-income countries in the hundreds of billions of US dollars annually․ The evidence from a number of studies found that ED-based interventions including SBIRT showed effectiveness for short-term reductions in alcohol consumption and increases in referral to treatment․ Results on long-term effects and implementation of SBIRT were also mixed․ Conclusions: The burden on health systems from alcohol-related ED utilization is large and increasing․ Further‚ it is not evenly distributed across the population․ EDs provide an important site of acute care and possible early intervention․ Policy implementation should adopt an integrated approach‚ combining ED-based implementations such as SBIRT with population-based alcohol control policies and targeting the collection of socioeconomic and structural determinants of health․ Future research should focus on implementation science‚ the sustainability and effectiveness of interventions over time‚ and the experience in low- and middle-income settings․