title: Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review.
abstract: Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes.
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: ctimko@stanford.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.affiliation: VA Boston Healthcare System, Boston, MA, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Below
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Schultz
authors.affiliation: VA Boston Healthcare System, Boston, MA, USA; Department of Psychology and Psychiatry, Boston University, Boston, MA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Brief
authors.affiliation: Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA; VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cucciare
mesh_terms: D000437:Alcoholism / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D003266:Continuity of Patient Care; D006801:Humans; D008605:Mental Health Services; D010360:Patient Transfer; D011613:Psychotherapy; D012657:Self-Help Groups; D013375:Substance Withdrawal Syndrome / Q000628:therapy*
keywords: Alcohol use disorders; Behavioral practices; Detoxification; Health care transitions; Systematic evidence review