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Predictors of dually diagnosed patients’ psychiatric symptom exacerbation during acute substance use disorder treatment
- Authors:
- TIMKO Christine, ILGEN Mark, MOOS Rudolf H.
- Journal article citation:
- Journal of Dual Diagnosis, 4(1), 2007, pp.55-74.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
A total of 230 dual diagnosis patients receiving treatment from 14 residential substance abuse programmes were evaluated at intake, discharge (98%) and one-year follow-up (80%). A higher risk of exacerbated psychiatric symptoms at discharge was associated with the following at intake: anxiety; being untroubled by psychiatric symptoms; using more than one substance; having less severe alcohol problems; living with a problem drinker; and having no close friends. Those who received, during their acute treatment, recommended services (e.g. individual counselling, vocational counselling, discharge planning) were more likely to improve even when intake risk was controlled. In addition, those who received outpatient treatment after discharge were more likely to have fewer psychiatric symptoms at one-year follow-up. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs
- Authors:
- TIMKO Christine, et al
- Journal article citation:
- Journal of Mental Health, 15(2), April 2006, pp.163-177.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
This American study evaluated the effectiveness and cost-effectiveness of community- and hospital-based acute residential treatment for dually disordered patients, and whether moderately-ill patients benefited more from community care, and severely-ill patients from hospital care. Two hundred and thirty patients with dual substance use and psychiatric disorders were randomly assigned to community or hospital acute care programs that had the same level of service-intensity. They were followed for 1 year (80%) using the Addiction Severity Index. Patients' health care utilization was assessed from charts, VA databases, and health care diaries; costs were assigned using methods established by the VA Health Economics Resource Center. Patients had better substance use outcomes when they were initially assigned to community rather than to hospital acute care. Patients assigned to hospital care had shorter index stays, but these index stays were more costly than were the longer index stays of patients assigned to community care. Patients assigned to hospital care also had more mental health follow-up outpatient visits, and more costly mental health follow-up stays, over the study year. The authors concluded that cost savings may be achieved without loss of benefit to all but the most decompensated dually disordered patients by shifting the locus of acute treatment from hospital to community care.