A Substance Abuse Consultation Service

Abstract

The authors review the literature on the high prevalence but underrecognition of substance abuse among hospitalized patients and the general unavailability of hospital-based substance abuse consultation services. They describe the development, clinical operations, staffing, and teaching activities of a large substance abuse consultation service in one urban academic medical center and detail the service's growth and changing utilization patterns over an 8-year period, reporting the clinical characteristics of 1,819 patients seen over a 1-year period. Differences in patient demographics, patterns of substance use, and diagnoses were highly significant from one referring service to another. The authors discuss the implications of such a service for patient care and teaching.

Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service

“…Hospital CL services specializing in substance use disorders offer a promising form of intervention that can help address the complex needs of those with ongoing medical problems that may be directly caused or exacerbated by substance use. Such services can feasibly be developed and integrated into hospital settings (Aszalos et al, 1999; Fuller and Jordan, 1994; McDuff et al, 1997; Murphy et al, 2009; Trowbridge et al, 2017; Wakeman et al, 2017). These service teams can focus on SUD-related problems (e.g., acute opioid withdrawal) and provide attending medical/surgical teams with recommendations regarding the management of such problems, augmenting the overall care of this population by directly addressing their SUD and related medical issues.…”

“…The University of Maryland Medical Center (UMMC) is a largely urban, tertiary care academic hospital with 750 beds, over 29,800 annual admissions, a level 1 Trauma Center with over 8,600 annual admissions, and over 61,400 observation and emergency department visits. It has a long-standing SUD CL service that has been in continuous operation for more than 3 decades (McDuff et al, 1997). This service sees patients from a variety of hospital units (e.g., internal medicine, surgery, trauma, labor, and delivery), and is called in whenever the medical/surgical team suspects that a patient may have a substance use problem.…”

“…In recognition of the important role that SUDs can play in patient health and medical prognosis, some hospitals have formed specialized SUD consultation-liaison (CL) services. Such CL services can provide specialist recommendations to the care team regarding withdrawal symptom management, initiation of SUD treatment in the hospital, and referrals to treatment, among other services (Aszalos et al, 1999; Fuller and Jordan, 1994; McDuff et al, 1997; Murphy et al, 2009; Trowbridge et al, 2017; Wakeman et al, 2017)…”

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

“…The included studies were published across >2 decades, spanning 1994 through 2022 (Table 1). 23,27,40–63 …”

Reason for Medical Hospitalization Among Adult Alcohol and Drug Abusers

“…All subjects were patients of the University of Maryland Medical System (UMMS) drug and alcohol consultation service that assists the medical, surgical, obstetrics, and trauma teams in the management of their patients with co‐morbid substance use problems 33 . The UMMS is a large, academic inner‐city hospital.…”