Treatment settings for persons with alcoholism: Evidence for matching clients to inpatient versus outpatient care.

Rychtarik, Robert G.; Connors, Gerard J.; Whitney, Robert B.; McGillicuddy, Neil B.; Fitterling, James M.; Wirtz, Philip W.

doi:10.1037/0022-006x.68.2.277

Cited by 62 publications

(66 citation statements)

References 29 publications

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“…It has been suggested that common factors are considerably more important for the outcome than the treatment methods in both psychotherapy and substance abuse treatment [20][21][22][23][24] . Taking into account the client's personal characteristics in treatment planning and provision is deemed relevant [25,26] .…”

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confidence: 99%

The female therapist and the client’s gender

Kuusisto

Artkoski²

2013

Clinical Nursing Studies

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Most Finnish substance abuse therapists are women, while the majority of clients are men. This study explores the gender-based differences in the therapeutic alliance, retention in therapy and outcomes between female therapists (N = 30) and their clients (N = 296, women 101, men 195) in outpatient treatment. Female clients were more likely to want a female therapist, whereas men did not express such preferences. The clients' estimation of the therapeutic alliance differed at the first visit: female clients estimated it to be better than did men. The therapists' estimations were not connected to client's gender. The combination of a female therapist and a female client predicted a better therapeutic alliance during treatment, but there were no differences between male and female clients in long-term outcomes. The findings suggested that clients received treatment of the same quality regardless of their gender.

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confidence: 99%

The female therapist and the client’s gender

Kuusisto

Artkoski²

2013

Clinical Nursing Studies

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“…Considering the background of standard treatment delivery and of a different health care system, where IP treatment of alcoholics is the norm, our results are surprisingly similar to other fi ndings concerning the effectiveness of IP and out-patient treatment [3] . Compared with the 4 controlled studies that actually included a DH or similar treatment condition [4,8,9,19] , some differences should be noted. Patients needing IP detoxifi cation were excluded from 3 of the 4 prior trials.…”

Section: Discussionmentioning

confidence: 99%

“…The latest meta-analysis on this topic by Finney et al [3] included only 13 controlled studies covering the period from 1972 to 1995, and only 3 of them compared IP with day hospital (DH) treatment. Since then, another randomised study was published by Rychtarik et al [4] , comparing IP treatment and two forms of out-patient treatments, where the inten-sive out-patient setting may be interpreted as equivalent to DH treatment. None of these trials was carried out in a European country.…”

Section: Introductionmentioning

confidence: 99%

“…Third, the representativeness of the study samples and of the interventions is questionable. For example, 3 of the 4 studies comparing IP to day treatment excluded patients in need of detoxifi cation [4,8,9] . Differences between settings may become evident with clients more typical of those seen at routine care institutions but who participate rarely in randomised trials [10] .…”

Section: Introductionmentioning

confidence: 99%

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A Randomised Clinical Trial of In-Patient versus Combined Day Hospital Treatment of Alcoholism: Primary and Secondary Outcome Measures

Weithmann

Hoffmann²

2005

Eur Addict Res

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In Germany, the treatment system for alcoholics is predominantly in-patient (IP) oriented, but no randomised trials of setting effects have been conducted until now. We examined if detoxification treatment offered in a day clinic setting would lead to results comparable to the usual IP treatment. After initial IP detoxification, patients (n = 109) at a standard withdrawal treatment unit were randomly assigned to IP or day hospital groups. In both settings, identical psychosocial treatment was given. In this article, results of primary (percent days abstinent and drinks per drinking day) and secondary outcome measures (relapses during treatment, premature termination, additional hospitalisation during follow-up, percent of voluntary abstinent days and continuous abstinence) are reported. Outcome measures were assessed quarterly during a 1-year follow-up period. Patients improved significantly after both treatments, but we found no significant setting or setting × time interaction effects for any primary or secondary outcome measure.

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“…This process is called matching by the Americans. 45 Finney et al claimed that previous revisions, as well as that performed by them, do not provide evidence for the superiority of inpatient over clinical treatment.…”

Section: Profile Of the Psychoactive Substance Treatment In Espirito mentioning

confidence: 99%

Psychoactive substances and the provision of specialized care: the case of Espirito Santo

Siqueira

Barbosa

Laranjeira

et al. 2007

Rev. Bras. Psiquiatr.

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A b s t r a c t Objective: In this study, we conducted a survey of all the institutions that provide treatment for psychoactive substances in the state of Espirito Santo, Brazil during the period [2004][2005]. Method: We used a snowball sampling technique to include all the treatment facilities in our State in which we employed a semi-structured interview instrument for key informants at each institution. We present descriptive results and test differences between groups using the Chi-square test. Results: In Espirito Santo, 250 institutions provide treatment for psychoactive substances and are distributed as follows: governmental (17.6%), nongovernmental (22.8%), and self-help groups (59.6%). Of these 250 institutions, 85 provide direct care, with the majority found in the Central region (70.6%) and followed by the Northern (15.3%) and Southern (14.1%) regions. The majority of those that provide direct care are private nonprofit centers (16.8%) institutions with ties to religious organizations make up nearly one-third (30.6%) of direct care providers. The drugs most consumed by those seeking care are alcohol (82.4%), tobacco (81.2%) and marijuana (68.2%). The institutions generally give assistance to people in the 26-45 years age group (89.4%); with regard to gender, the institutions take care of: men (31.8%), women (5.9%), and both sexes (56.5%). The treatment models most used are psychosocial (58.8%), therapeutic community (47.1%) and biomedical (43.5%) and the work is evaluated through the team technique (72.9 %). Conclusions: In the state of Espirito Santo, indirect care services are many times greater than those that offer direct care and the majority of all services are in the Central region. The populations in the mainland have a comparative disadvantage when it comes to treatment options for psychoactive substance use. We observed that a significant number of institutions that provide drug abuse treatment have financial support from religious organizations. The Espirito Santo State survey demonstrates the necessity of a decentralized provision of specialized care for psychoactive substance users, with substantially more services directed to the Northern and Southern regions of the state. Moreover, the emphasis of these new institutions should be on outpatient care.Descriptors: Psychoactive substances; Health, public; Healthcare surveys; Substance abuse; Health services evaluation Resumo Objetivo: Foi realizado um levantamento de todas as instituiçõesque proporcionam tratamento para dependência de substâncias psicoativas no Estado do Espírito Santo, Brasil, durante o período de [2004][2005]. Método: Foi utilizado o método de amostragem bola-de-neve para incluir todos os estabelecimentos de tratamento no Estado e empregada uma entrevista semi-estruturada para informantes-chave em cada instituição. Os resultados descritivos foram apresentados e as diferenças testadas entre os grupos, utilizando o teste de qui-quadrado. Resultados: No Espírito Santo, 250 instituições proporcionam tratamento para dependência...

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Treatment settings for persons with alcoholism: Evidence for matching clients to inpatient versus outpatient care.

Cited by 62 publications

References 29 publications

The female therapist and the client’s gender

The female therapist and the client’s gender

A Randomised Clinical Trial of In-Patient versus Combined Day Hospital Treatment of Alcoholism: Primary and Secondary Outcome Measures

Psychoactive substances and the provision of specialized care: the case of Espirito Santo

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