Hazardous Drinking Linked to Higher Psychotropic Prescriptions in Depression

A three-year follow-up study embedded within a Swedish randomized controlled trial has revealed that patients with depression who reported hazardous alcohol consumption at baseline were more likely to be prescribed psychotropic medication than those with non-hazardous consumption. The research, published in Scientific Reports, analyzed registry data from 929 patients who had received treatment for depression but did not receive specific interventions targeting their alcohol use. The findings suggest a complex interplay between mental health treatment, substance use, and healthcare utilization, highlighting that clinicians may prescribe medication more frequently to patients with comorbid hazardous drinking, even if the total quantity of medication dispensed does not differ significantly between the groups.

The study built upon the Regassa trial, a large-scale multicenter randomized controlled trial conducted in Swedish primary care between 2011 and 2014. The original trial investigated the efficacy of internet-based cognitive behavioral therapy and physical exercise compared to treatment as usual for patients with mild to moderate depression. For this secondary analysis, the researchers divided the cohort into two subgroups based on their self-reported alcohol consumption at baseline, using the Alcohol Use Disorder Identification Test (AUDIT).

Patients with alcohol use disorder were excluded, ensuring the focus remained on hazardous consumption without dependence. Approximately 22% of the participants reported hazardous alcohol use, a proportion predominantly composed of men, while the majority of the cohort consisted of women. The primary outcome of the study was the utilization of healthcare services and the prescription of psychotropic and opioid medications over a 36-month period.

The researchers linked the participant data to the Swedish National Patient Register for specialized outpatient care and regional primary care registers. They also utilized the Swedish Prescribed Drug Register to track dispensed medications, categorized by the Anatomical Therapeutic Chemical (ATC) classification system. Medication use was measured using defined daily doses (DDD), which represents the assumed average maintenance dose per day for a drug used for its main indication in adults.

This comprehensive registry-based approach allowed for a detailed examination of long-term healthcare patterns. The statistical analysis revealed that patients with hazardous alcohol consumption had higher odds of receiving psychotropic medication during the overall follow-up period. After adjusting for age, sex, treatment group, and baseline depressive symptom severity, the adjusted odds ratio was 1.49, indicating a statistically significant association.

However, among patients who actually received prescriptions, there were no significant differences in the number of defined daily doses of psychotropic medication between the two groups. This suggests that while clinicians may be more inclined to prescribe medication to patients with hazardous alcohol use, the intensity of treatment, as measured by dosage, remains similar once the medication is initiated. Healthcare utilization patterns also differed between the subgroups.

Patients reporting hazardous alcohol consumption generally had fewer healthcare visits overall compared to those with non-hazardous consumption. This trend was particularly evident in visits for pain diagnoses, where the hazardous use group had significantly fewer consultations in the first two years of follow-up. The authors noted that this lower utilization for pain may be related to the potential analgesic effects of alcohol, which could reduce the perceived need for medical intervention for pain management.

This finding aligns with previous research suggesting that individuals with hazardous drinking patterns may underutilize healthcare services for certain conditions. Regarding opioid use, the study found no significant differences in the odds of receiving opioid prescriptions between the two groups. However, among those who did receive opioids, there was a tendency for patients with hazardous alcohol use to use lower levels of opioids over time.

Specifically, in the 13 to 24-month period, the incidence rate ratio for opioid use was 0.52, suggesting a lower rate of use in the hazardous consumption group. Although this association did not reach statistical significance after adjustment, it supports the hypothesis that hazardous alcohol use may be associated with reduced opioid utilization, possibly due to differences in pain reporting and seeking behavior. The authors discussed several potential explanations for these findings.

One possibility is that the treatment for depression, while effective in reducing depressive symptoms, did not significantly alter alcohol consumption patterns in the hazardous use group. Previous analyses from the Regassa trial indicated that alcohol consumption remained at hazardous levels even after depression treatment, suggesting that addressing depression alone may not be sufficient to modify drinking behavior. This underscores the importance of considering both mental health and substance use in clinical assessments.

The higher odds of prescribed psychotropics among patients with hazardous alcohol use may also indicate that treatment for depression has limited effect in modifying drinking behavior. The study has several limitations that must be considered when interpreting the results. As a secondary analysis of subgroups within a randomized controlled trial, the study was not specifically powered to detect differences between the alcohol consumption groups, and the findings should be viewed as exploratory.

Additionally, the absence of follow-up data on alcohol consumption and depression severity limits the ability to determine causality or understand how these factors evolved over time. The cut-off values for hazardous alcohol consumption were based on Swedish guidelines, which may limit the generalizability of the findings to other populations with different drinking patterns and healthcare systems. Despite these limitations, the study provides valuable insights into the healthcare utilization and medication patterns of patients with depression and hazardous alcohol use.

The findings suggest that screening for alcohol consumption during the assessment of patients with depression is crucial for ensuring tailored and effective treatment. In conclusion, this study demonstrates that hazardous alcohol consumption in patients with depression is associated with higher odds of psychotropic prescription, despite lower overall healthcare utilization.

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

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

Article References: Strid, C., Lundin, A., Forsell, Y., & Öjehagen, A. (2026). Subgroup analyses by baseline alcohol consumption of 3-year psychotropic and opioid use and healthcare utilization in patients treated for depression. Scientific Reports, 16(1), Article 33524. https://doi.org/10.1038/s41598-026-76635-1

Image Credits: AI Generated

DOI: 10.1038/s41598-026-76635-1

Keywords: depression, alcohol consumption, psychotropic medication, opioid use, healthcare utilization, randomized controlled trial, Swedish primary care, comorbidity, registry data, AUDIT, Subgroup, analyses