Hazardous alcohol use among patients with psychiatric disorders: Findings from phosphatidylethanol (PEth) screening in healthcare

Identifying hazardous alcohol use among patients with psychiatric disorders is important for improving treatment outcomes. This study aimed to describe the prevalence of hazardous alcohol use across 20 psychiatric diagnoses using phosphatidylethanol (PEth) blood sampling. We conducted a cross-sectional analysis of PEth samples collected between 2017 and 2023 from a regional Swedish healthcare database, linked to clinician-assessed psychiatric diagnoses. Participants were adults (≥18 years) with a psychiatric disorder (N = 18,240). Hazardous alcohol use was defined as a PEth concentration > 0.30 µmol/L (∼210 µg/L). Marginal risk ratios (RR) were estimated using logistic regression adjusted for sex, age, comorbidity, season, and healthcare setting. In the sample (mean age: 40 years; 58.7 % female), 7.4 % screened positive for hazardous use. The highest prevalence was observed in patients with substance use disorder (12 %, RR: 1.87, 95 % CI: 1.57-2.23) and panic disorder (8.8 %, RR: 1.43, 95 % CI: 1.19-1.70). Lower prevalence was seen in patients with exhaustion syndrome (5.4 %), ADHD (5.0 %), and obsessive-compulsive disorder (4.2 %). Panic disorder remained significantly associated with hazardous use after adjustment. Male sex (RR: 1.79, 95 % CI: 1.58-2.02) and age, with the highest risk observed around 60 years, were both strongly associated with increased risk. Hazardous alcohol use is prevalent among patients with psychiatric disorders when assessed with PEth. Targeted screening, especially among older men and patients with panic disorder, may improve identification and intervention.