Use of pharmacotherapy for alcohol use disorders and the risk of unemployment: a cohort study of 77 503 workers in Sweden.

Abstract

Alcohol use disorders (AUDs) can lead to unemployment, yet they remain undertreated. Pharmacotherapies may strengthen labour market attachment but are underused. This study investigates the association between AUD pharmacotherapy use and the risk of becoming unemployed among individuals with an AUD diagnosis in Sweden. A longitudinal register-based study was conducted, using the Swedish Work, Illness and labour market Participation (SWIP) cohort, restricted to gainfully employed individuals between 16 and 60 years with a first-time AUD diagnosis in Sweden between 2006 and 2019 (n=77 503). The exposure was AUD pharmacotherapy use. The outcome was the first unemployment spell (≥90 consecutive days) that occurred after the first-time AUD diagnosis (2006-2020). Covariates included sociodemographic characteristics, comorbidities and unemployment history. The association between pharmacotherapy use and unemployment was examined using Cox regression models. Of the cohort, 42.8% used AUD pharmacotherapy and 15 098 individuals became unemployed during the observation period (median 7.1 years, IQR 3.3-10.6 years). Relative to those with AUD who did not use any pharmacotherapy, an inverse association between the use of AUD pharmacotherapy and unemployment incidence was observed (adjusted HR (aHR): 0.86; 95% CIs 0.82 to 0.89). AUD pharmacotherapy may decrease the risk of long-term unemployment. The findings further underscore the importance of pharmacotherapy treatment to sustain work ability and promote a healthy workforce.