Inpatient alcoholism treatment: Who benefits?

Abstract

Although uncontrolled studies have yielded mixed findings, 26 controlled comparisons have consistently shown no overall advantage for residential over nonresidential settings, for longer over shorter inpatient programs, or for more intensive over less intensive interventions in treating alcohol abuse. Predictor data suggest that intensive treatment may be differentially beneficial for more severely deteriorated and less socially stable individuals. The outcome of alcoholism treatment is more likely to be influenced by the content of interventions than by the settings in which they are offered. Third-party reimbursement policy shouM discourage the use of intensive residential models for addressing alcohol abuse when more cost-effective alternatives are available and should reinforce the use of research-supported treatment methods regardless of setting. Such policy priorities run directly counter to the current practices and financial interests of many for-profit providers.

Does centralized intake improve drug abuse treatment outcomes?

“…These findings are consistent with literature showing that, over time, clients entering drug abuse treatment tend to show improved outcomes (Hubbard et al, 1989;Miller and Hester, 1986;Simpson and Sells, 1990). The absence of CIU effects or CIU by time interactions suggests that, while both CIU and non-CIU groups improved, one group did not improve more than the other.…”

“…Two-thirds of all substance abuse treatment is provided in the public sector (Mechanic, Schlesinger and McAlpine, 1995). Treatment has been shown effective in reducing drug and alcohol use, in ameliorating associated health and social problems among those treated (McLellan, Luborsky, O'Brien, Woody and Druley, 1982;Hubbard et al, 1989;Miller and Hester, 1986;Simpson and Sells, 1990), and in reducing economic costs associated with substance abuse (Finigan, 1996;Gerstein et al,1994).…”

Have we evaluated addiction treatment correctly? Implications from a chronic care perspective

“…For example, the series of comparisons between in-patient, residential and outpatient settings of addiction treatment (e.g. Miller & Hester 1986;McKay et al 1995) simply do not make sense from a continuing care perspective. Again, if treatments are expected to produce symptom reduction only as long as the patient is actively involved in that treatment, then there should be no post-treatment differences among patients assigned to any of those modalities-the common finding from these evaluations (see McLellan et al 1996).…”

Treatment of alcohol dependence

“…24,25 One exception to this is the study by Walsh et al, 26 which showed that among workers referred to an employee assistance program, those who were randomly assigned to a 3-week inpatient alcohol treatment program had significantly better alcohol-related outcomes than workers who were assigned to mandatory AA attendance only. Workers assigned to a third group were allowed to choose their treatment and had outcomes intermediate between the other two groups.…”