title: Outpatient treatment engagement and abstinence rates following inpatient opioid detoxification.
abstract: Many patients with chronic opioid dependence are referred to drug-free outpatient treatment following inpatient detoxification even though successful outpatient treatment engagement and abstinence from opioids occur only in a minority of cases. This retrospective cohort analysis of medical records documents the post-discharge outcome in a treatment setting that maximizes the support during transition to abstinence-oriented outpatient care, with comprehensive social, medical and mental health services, including the availability of naltrexone. Participants were male veterans (N = 112) admitted at an urban VA medical center. Most patients (78%) successfully completed acute detoxification, 49% initiated naltrexone, and 76% accepted a VA aftercare plan. At 90-day follow-up, only 22% remained in aftercare, and < 3% had toxicology-verified abstinence from opioids. At one-year follow-up, 1 out of 5 had been readmitted for detoxification and 4.5% had died. Most patients successfully detoxified from opioids, but very few remained engaged and stabilized in abstinence-oriented outpatient treatment.
authors.affiliation: Va Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seatte, WA 98195, USA. John.Davison@va.gov
authors.forename: John W
authors.initials: JW
authors.lastname: Davison
authors.forename: Marie L
authors.initials: ML
authors.lastname: Sweeney
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Bush
authors.forename: Tania M
authors.initials: TM
authors.lastname: Davis Correale
authors.forename: Donald A
authors.initials: DA
authors.lastname: Calsyn
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Reoux
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Sloan
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008658:Inactivation, Metabolic; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011615:Psychotherapy, Group; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone