Inpatient alcohol treatment in a private healthcare setting: which patients benefit and at what cost?

This study investigated whether selected patients have better outcomes with inpatient than outpatient treatment. There were 93 inpatients and 80 outpatients with alcohol dependence who were evaluated at treatment entry to a private healthcare setting. Patients with multiple drinking-related consequences were less likely to return to significant drinking in the first 3 months after treatment ended if they had attended inpatient compared to outpatient treatment. Thus, inpatient appeared to have some advantage over outpatient treatment in the early recovery period for patients with multiple drinking-related consequences. The gap between inpatient and outpatient costs was also reduced when computed as a cost-effectiveness ratio, although treatment costs continued to remain proportionally higher with inpatient than outpatient treatment.

The natural history of outpatient alcohol and drug abuse treatment in a private healthcare setting.

Managed healthcare has had a major impact on the delivery of alcohol and drug abuse treatment services in the private setting, primarily by shifting patient enrollment from inpatient to outpatient treatment programs. The purpose of this study was to investigate the natural history of outpatient alcohol and drug abuse treatment in a private, nonprofit healthcare setting. Patient profiles at pretreatment, their attendance record in a 6-week outpatient program, and their outcome in the year after treatment were evaluated in 120 patients with a DSM-III-R diagnosis of alcohol and/or cocaine dependence. There were 70 outpatients who successfully completed the program, and 50 who did not. Two subtypes of outpatient treatment failures were identified: S5 who prematurely left treatment against medical advice (n = 23), and S8 who attended treatment but continued heavy use of substances (Treatment Resistant, n = 27). A logistic regression revealed that younger age, multiple prior treatments, and employment problems were related to outpatient treatment failure. Outpatient failures did not immediately seek alternative treatment, and most of them continued heavy substance use in the year post-treatment: i.e., 82% vs. 43% successful completers (chi 2 = 13.8, df = 1, p < 0.01). Thus, there were a clinically relevant number of outpatient failures (42%), either because of lack of program attendance or continued substance use throughout treatment. These behaviors were related to continued heavy use of substances in the year after treatment.

Patient attitudes toward electroconvulsive therapy.

Electroconvulsive therapy (ECT), a safe and effective treatment for major depression, has been more harshly criticized than any other psychiatric treatment. Despite widespread negative public opinion, clinical impressions that are supported by limited empirical data suggest that patients who benefit from ECT do not share these negative sentiments. This study surveyed attitudes toward ECT in 78 depressed inpatients, twice during hospitalization and at 6 months after discharge, using a semi-structured interview. Significantly more ECT-treated patients (n = 56) were favorable about ECT, compared to depressed patients (n = 22) never treated with ECT, both at pretreatment (chi square = 8.4, df = 1, p < .01) and at post-treatment (chi square = 12.5, df = 1, p < .01). Favorable attitudes were maintained after 6 months. ECT-treated patients, initially uncertain or negative about ECT, changed to a favorable attitude after completing treatment. Ninety-eight percent of ECT-treated patients said they would agree to ECT if they became depressed again.