Inpatient substance abuse care and the outcome of subsequent community residential and outpatient care.
OBJECTIVE
To compare participation in treatment and 1-year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care.


METHODS
Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1-year follow-up.


RESULTS
Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1-year follow-up. In addition, when they entered CRF care directly, patients with co-morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1-year follow-up.


CONCLUSIONS
Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care.
Moos
R H
RH
Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, Palo Alto, California 94304, USA. bmoos@stanford.edu
Finney
J W
JW
Moos
B S
BS
D000328:Adult; D000553:Ambulatory Care; D000704:Analysis of Variance; D003156:Community Mental Health Services / Q000458:organization & administration*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology; D012114:Residential Treatment / Q000379:methods; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome