Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People

Abstract

Background This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group. Methods We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year. Results Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR = .96, 95% CL = .94, .99, P = .002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status. Conclusions The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.

Alcohol detoxification completion, acceptance of referral to substance abuse treatment, and entry into substance abuse treatment among Alaska Native people

“…Our analysis revealed that higher GAF scores were associated with detoxification treatment completion. This is similar to previous alcohol detoxification research that found higher levels of functioning were associated with a decrease in detoxification readmissions (Running Bear et al, 2014). This suggests patient functioning is an important indicator of successful alcohol detoxification completion.…”

“…Li, Sun, Marsh, & Anis, 2008; Mark, Vandivort-Warren, & Montejano, 2006). The one year readmission rate for Alaska Native people is 42% (Running Bear et al, 2014). These high rates imply a failure by the health care system to provide adequate services to detoxification patients.…”

“…At the patient level, age, gender, unemployment, homelessness, patient functioning, a preferred substance of alcohol, and Medicaid coverage are associated with readmission to detoxification (Callaghan, 2003; Carrier et al, 2011; X. Li et al, 2008; Mark et al, 2006; Running Bear et al, 2014). …”

Social factors and readmission after inpatient detoxification in older alcohol‐dependent patients

“…Studies in adult alcohol‐dependent patients have shown that a long history of heavy drinking, high daily alcohol consumption, previous alcoholism treatments, and poor adaptive functioning (as measured with the Global Assessment of Functioning (GAF) score) at admission to a detoxification facility are predictive of readmission after detoxification. The number of previous hospitalizations was predictive of the time to readmission as well .…”

Gender Differences among Alaska Native People Seeking Alcohol Withdrawal Treatment

“…33 Alcohol abuse is the second leading cause of death among Alaska Native women aged 25–54. 33 Overall, the 1-year readmission rates to alcohol detoxification for Alaska Native people is 42%, 34 compared with 27% among patients receiving publicly funded detoxification services in the United States. 35 …”