A Substance Abuse Consultation Service:Enhancing the Care of Hospitalized Substance Abusers and Providing Training in Addiction Psychiatry

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.

What General Psychiatrists Ask Addiction Psychiatrists: A Review of 381 Substance Abuse Consultations in a Psychiatric Hospital

“…Clinical training capacities of services providing psychiatry consultation to substance abuse treatment units have been previously described. 35 In summary, our ¢ndings support previous research demonstrating that there is a high prevalence of substance use disorders among general psychiatry inpatients and that many have never received substance abuse treatment. General psychiatrists on these units made use of the substance abuse consultation service to enhance diagnostic evaluation of substance use disorders among individuals with other psychiatric disorders and to recommend substance abuse treatment and aftercare.…”

“…32 A number of other investigators have described consultation services designed to enhance recognition, diagnosis, and referral for treatment of those patients with co-occurring substance use disorders who are hospitalized in general medical settings. 33^35 For example, several studies describe substance abuse consultation services in large academic medical centers 4,33,35 as well as the results of a substance abuse consultation service's interventions in a medical/surgical trauma center. 36 We have been interested in the ways a substance abuse consultation service can enhance the clinical work being provided by general psychiatrists treating patients in inpatient and day treatment psychiatric services settings.…”

Managing acutely III substance-abusing patients in an integrated day hospital outpatient program

“…Earlier research also found that the specialty drug treatment system serves only a small proportion of heavy drug users in the community, while large numbers of out‐of‐treatment individuals are instead found accessing social service agencies, incarcerated, or in health care facilities (emergency departments and hospitals) 18 . Hospital‐based structural interventions have typically consisted of consult‐liaison services and provider‐administered brief interventions, both of which have generated significantly improved rates of successful referral or reductions in problem drinking compared with usual care 19–22 . Outpatient approaches for more clinically stable patients have usually started with clients enrolled in a treatment program and integrating and coordinating treatment with specialty 14 or primary medical care 15 .…”

“…18 Hospitalbased structural interventions have typically consisted of consult-liaison services and provider-administered brief interventions, both of which have generated significantly improved rates of successful referral or reductions in problem drinking compared with usual care. [19][20][21][22] Outpatient approaches for more clinically stable patients have usually started with clients enrolled in a treatment program and integrating and co-ordinating treatment with specialty 14 or primary medical care. 15 In all of these approaches, the common feature is that they avail of an inherent illness-driven motivation to facilitate a behavior change.…”

Cliniciansʼ evaluation and management of mental health, substance abuse, and chronic pain conditions in the intensive care unit*

“…For example, forcing oneself to consider a secondary workup after an initial diagnosis helps avoid the tendency to call off a diagnostic "search" too soon once an expected or satisfying finding emerges (77). At the systems level, consulting subspecialties, such as pain or psychiatric liaison services, addiction medicine/substance abuse consultation services (78,79), or doctors of pharmacy, can be invited to assist in MHSA and CP history taking, evaluation, and management.…”