Outcomes of residential treatment of substance abuse in hospital- and community-based programs.
OBJECTIVE
The study sought to determine whether inpatient readmission rates differed for patients with substance use disorders who were treated in either hospital-based or community-based transitional residential care. Length of residential care and intensity of outpatient mental health aftercare were examined as predictors of readmission.


METHODS
Department of Veterans Affairs nationwide databases were used to document readmissions at one- and two-year intervals for male inpatients treated for substance use disorders who were discharged either to hospital-based (N = 2,190) or community-based (N = 4,490) residential care. Patients with and without concomitant psychiatric diagnoses were identified.


RESULTS
Patients treated in community-based residential programs had lower one- and two-year readmission rates than patients who received hospital-based residential care. Longer episodes of residential care and more outpatient mental health care were also associated with lower readmission rates. Among patients with concomitant psychiatric disorders, those in hospital-based care benefited more from longer episodes of residential care and more intensive outpatient mental health aftercare. Residential care, longer episodes of care, and more outpatient mental health care were independent predictors of lower one- and two-year readmission rates after patient-based risk factors were controlled.


CONCLUSIONS
The findings highlight the value of providing adequate amounts of residential and outpatient care for patients in substance abuse treatment, especially patients with concomitant psychiatric disorders.
Moos
R H
RH
Program Evaluation and Resource Center, Veterans Affairs Medical Center, Palo Alto, California 94304, USA.
King
M J
MJ
Patterson
M A
MA
D000328:Adult; D000359:Aftercare; D000368:Aged; D003156:Community Mental Health Services; D015897:Comorbidity; D006801:Humans; D013287:Illicit Drugs; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D010359:Patient Readmission; D011567:Psychiatric Department, Hospital; D011619:Psychotropic Drugs; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology
D013287:Illicit Drugs; D011619:Psychotropic Drugs