Admission criteria for inpatient substance abuse/dependence rehabilitation: implications for managed care.

In view of recent trends toward the replacement of traditional inpatient rehabilitation programs with nonresidential services, we examined the extent to which patients currently admitted to inpatient rehabilitation for alcohol or drug abuse/dependence met published criteria suggesting a preferential need for inpatient or residential care. Over 90% of almost 300 veterans with a primary DSM-III R diagnosis of alcohol or substance abuse/dependence, admitted to six New York Metropolitan Area Veterans Administration Medical Centers for inpatient rehabilitation, met at least one criterion dimension considered indicative of a need for such services, with over two-thirds meeting two or more dimensions. These findings suggest a continuing need for initial primary inpatient or residential rehabilitation for such patients.

A placebo-controlled trial of L-dopa/carbidopa in early cocaine abstinence.

Thirty patients with primary cocaine dependence who had used cocaine within the past 24 hours and were being admitted to a detoxification ward were rated for signs and symptoms of cocaine abstinence and craving. They then received four doses of either L-dihydroxy-phenylalanine/carbidopa (100 mg/25 mg) or placebo over the next day. Ratings were repeated in the late afternoon of the day of admission and after the final morning dose the next day. No significant differences in abstinence scores were found between the two treatment groups. The lack of drug-placebo differences appeared to be mainly due to rapid clearing of abstinence symptoms in the placebo-treated patients.