title: Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation.
abstract: We compared the effectiveness and costs of day hospital (DH) versus inpatient (INP) rehabilitation for cocaine dependence. The research subjects were 111 inner city, lower socioeconomic, primarily African-American male veterans who qualified for a diagnosis of cocaine dependence and presented no acute medical or psychiatric conditions requiring inpatient treatment. Fifty-six men were randomly assigned to 1 month of DH rehabilitation (27 hours of weekday treatment weekly), and 55 were assigned to 1-month INP rehabilitation (48 hours of scheduled treatment weekly). Treatment outcome was evaluated 7 months after admission into treatment (92% of the subjects), and a cost analysis was performed. A significantly greater proportion of INP subjects (89.1%) completed treatment than did DH subjects (53.6%). Significant improvements in substance use, psychosocial functioning, and health status were found 7 months postadmission for both groups, but there was little evidence of differential improvement between groups. Urine toxicology findings were consistent with the self-report data in showing improvement from baseline, but no group differences in cocaine use. The groups did not differ significantly in post-rehabilitation aftercare participation or in relapse to additional treatment. DH treatment costs were 40% to 60% of INP treatment costs, depending upon the measure used.
authors.affiliation: Veterans Affairs Penn Addiction Research Center, Philadelphia, Pennsylvania.
authors.forename: A I
authors.initials: AI
authors.lastname: Alterman
authors.forename: C P
authors.initials: CP
authors.lastname: O'Brien
authors.forename: A T
authors.initials: AT
authors.lastname: McLellan
authors.forename: D S
authors.initials: DS
authors.lastname: August
authors.forename: E C
authors.initials: EC
authors.lastname: Snider
authors.forename: M
authors.initials: M
authors.lastname: Droba
authors.forename: J W
authors.initials: JW
authors.lastname: Cornish
authors.forename: C P
authors.initials: CP
authors.lastname: Hall
authors.forename: A H
authors.initials: AH
authors.lastname: Raphaelson
authors.forename: F X
authors.initials: FX
authors.lastname: Schrade
mesh_terms: D000328:Adult; D000359:Aftercare; D003042:Cocaine / Q000652:urine; D003365:Costs and Cost Analysis; D003631:Day Care, Medical / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012917:Social Adjustment; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000534:rehabilitation* / Q000652:urine; D016896:Treatment Outcome
chemical_list: D003042:Cocaine