Crack/cocaine abusers in the general hospital: assessment and initiation of care.
OBJECTIVE
Cocaine, either smoked (as "crack") or taken intranasally, is now a common cause of psychiatric illness. This study was designed to assess the impact of cocaine abuse on a general psychiatric service and an obstetrics service in an urban general hospital and to evaluate a program for engaging affected patients in addiction treatment.


METHODS
The charts of 300 general psychiatric patients (not admitted for addiction treatment) and 60 cocaine-abusing prenatal or postpartum patients were reviewed. A treatment referral program based on professionally directed peer leadership was established for patients with cocaine abuse. Results of evaluation and referral of 100 other cocaine-abusing psychiatric patients and the 60 prenatal or postpartum patients were then determined.


RESULTS
Fully 64% (N = 191) of the 300 psychiatric patients were diagnosed as substance abusers; 38% (N = 113) of them abused cocaine. Almost one-third of these cocaine abusers had no axis I diagnosis other than substance abuse/dependence, and the majority were homeless. Urine samples were positive for cocaine in a majority of the obstetric patients studied. A majority of the psychiatric patients who were referred through the peer-led program enrolled in outpatient cocaine treatment--three times as many as in the chart review group. Most of the obstetric patients suitable for referral enrolled for treatment as well.


CONCLUSIONS
Cocaine abuse may be responsible for a large portion of psychiatric admissions in urban public general hospitals. Cocaine abusers in psychiatric and obstetrics services are apparently responsive to a peer-oriented mode of referral into treatment.
Galanter
M
M
Department of Psychiatry, New York University School of Medicine, NY 10016.
Egelko
S
S
De Leon
G
G
Rohrs
C
C
Franco
H
H
D000328:Adult; D003042:Cocaine; D015897:Comorbidity; D016578:Crack Cocaine; D005260:Female; D006703:Ill-Housed Persons; D006760:Hospitalization / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012017:Referral and Consultation; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000453:epidemiology*
D016578:Crack Cocaine; D003042:Cocaine