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

Abstract

Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.

Substance use treatment barriers for patients with frequent hospital admissions

“…Because both treatment modalities have proven more effective in treating opioid dependence than "medicationfree" psychosocial treatment alone (O'Toole et al, 2006), efforts on the part of hospital providers to better promote and facilitate transition to opioid agonist therapy, including buprenorphine, would be expected to reduce repeat detoxification and other opioid use-related admissions.…”

A Transitional Opioid Program to Engage Hospitalized Drug Users

“…7-27 Similar to programs described by Aszalos and O'Toole, TOP participants were hospitalized; however, our program employed a single nurse who performed inpatient initial contact and screening through to final outpatient taper or referral to maintenance treatment in an OTP. [13][14][15] The program provided the hospital-based clinical team an option for addressing opioid dependence. The TOP model appears sustainable and replicable using a modest staffing model (one nurse) and basic coordination within existing treatment services.…”

“…8 Research programs targeting hospitalized opioid-dependent patients have combined engagement with intensive, structured substance use treatment. [13][14][15] However, patients ambivalent about formal addiction treatment may be disinclined to enroll or remain in these types of programs. We created a clinical model to improve comprehensive health and lifestyle outcomes (e.g., linkage and adherence to treatment, reduction in unhealthy substance use behaviors) and promote low-threshold access that might engage reluctant patients.…”

Treatment seeking and subsequent 1-year drinking outcomes among treatment clients in Sweden and the U.S.A.: A cross-cultural comparison

“…In contrast, less resourced and more severely impaired clients in the U.S. tend to rely more on disjointed service agencies and mutual-help groups. Marginalized persons (as defined by homeless literature) with often co-occurring drug and psychiatric problems (Cunningham & Blomqvist, 2006) tend to rely more on acute care services for immediate needs (Kushel, Vittinghoff, & Haas, 2001; O'Toole et al, 2006) rather than substance use treatment programs. In summary, the Swedish catchments appear to be broader than in the U.S.; hence, the system as a whole intervenes upon individuals with a wider range of severities.…”