Statement of purpose Alcohol-involved overdose deaths have increased in recent years and often occur in combination with other substances. To inform overdose prevention efforts, this study assessed patient characteristics and treatment utilization among Veterans who died from alcohol-involved overdoses nationally.

Methods/Approach Using Veterans Health Administration (VHA) records linked to National Death Index data from 2012 to 2017, trends in overdose mortality were examined and patient characteristics and treatment receipt were compared across alcohol overdose categories (alcohol alone, alcohol+opioids, alcohol+other substances).

Results Across the study period, 1497 Veterans died from alcohol overdose alone, 1078 Veterans died from alcohol+opioids and 289 died from alcohol+other substances. Veterans who overdosed on alcohol+opioids and alcohol+other substances were more likely to be homeless, live in urban areas, and more likely to have comorbid depressive disorder and stimulant use disorder. Only a minority of patients who died from alcohol-involved overdose were seen in substance use disorder treatment settings within a year before their death, but the majority were seen in either mental health or primary care settings. Only about 7% of Veterans who died from alcohol overdose received any medication treatment for alcohol use disorder in the year prior to their deaths.

Conclusions The vast majority of patients who died from alcohol overdose did not receive treatment in substance use disorder settings or effective medication treatments.

Significance This study is the first to examine treatment characteristics of people who died from alcohol-involved overdose and suggests further efforts are needed to prevent the spectrum of alcohol overdose deaths including implementing alcohol use disorder treatment in settings outside of substance use disorder settings.