Predicting length of stay by patients hospitalized for alcoholism of drug dependence

Compulsory treatment of alcoholism: the case against

The need for compulsory detention in the management of alcohol-dependent persons is reviewed with a particular focus on legislation in New South Wales (NSW). It is argued that there is no justification for the severe loss of civil liberties in order to provide a general power of involuntary alcoholism treatment since such treatment is basically ineffective and in any case little treatment is actually given to those detained. The selective operation of the NSW Inebriates Act (in terms of class and race biases) is noted. The special circumstances of those who suffer severe alcohol-related brain damage and those who are in acute life-threatening circumstances are discussed. It is suggested that these cases are adequately covered by existing Mental Health and Guardianship legislation, obviating the need for special legislation such as an Inebriates Act.

Gender differences in hostility of opioid-dependent outpatients: role in early treatment termination

The purpose of this study was to evaluate gender differences in hostility and the role of hostility in predicting early treatment termination of opioid-dependent outpatients. Demographic characteristics and Addiction Severity Index (ASI) ratings were collected from 104 patients (68 males and 36 females) at intake to a buprenorphine treatment program. Hostility was assessed using the Buss-Durkee Hostility Scale. Compared to male opioid-dependent patients, females scored significantly higher on this scale. Early treatment termination was defined as remaining in treatment < 30 days, and 13% percent of males and 25% of females were classified as early terminators. Stepwise logistic regression identified predictors of early treatment termination. Severity of legal and employment problems and the interaction between hostility and gender predicted early treatment termination status. Patients with less severe legal problems and patients with greater employment problems were more likely to terminate early from treatment. Higher levels of hostility predicted early treatment termination of female patients, but hostility levels were not associated with treatment termination in male patients. Results from this study show that female heroin addicts have high levels of hostility and suggest that hostility may be an important predictor of premature discharge from opioid substitution programs, especially among women.

Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout

This study examines (a) the relation of initial treatment motivations to alcoholics' involvement in outpatient treatment and dropout and (b) the relations among patient characteristics, severity, alcohol expectancies, motivation, and treatment retention. A treatment motivation questionnaire (TMQ) was developed to assess both internalized and external motivations for treatment, as well as confidence in the treatment and orientation towards interpersonal help seeking. In Study 1, the TMQ was administered to 109 outpatients entering an alcoholism clinic. Based on these data the scale was revised and was administered to a subsequent sample of 98 subjects seeking treatment. Information about demographic variables, measures of substance use, alcohol expectancies, and psychiatric severity was also gathered. Eight weeks after intake, outcome was evaluated through attendance records and clinician ratings. Results revealed that internalized motivation was associated with greater patient involvement and retention in treatment. Subjects high in both internalized and external motivation demonstrated the best attendance and treatment retention while those low in internalized motivation showed the poorest treatment retention while those low in internalized motivation showed the poorest treatment response, regardless of the level of external motivation. Problem severity was also related to a greater degree of internalized motivation. The importance of initial motivations in understanding treatment response and dropout is discussed.

Irregular discharges from a dual diagnosis unit

Irregular discharges, previously studied on psychiatric or substance abuse treatment units, are a particular problem for dual diagnosis units. We examined demographic and clinical variables for their association with irregular discharge from an acute dual diagnosis inpatient unit, retrospectively reviewing 316 consecutive admissions. One hundred and nineteen patients (37.7%) were irregularly discharged (61 AMA, 31 administrative, 27 elopements), staying an average of 18.8 days compared with 51.4 days for those regularly discharged (p < .001). Younger age (p = .007) and discharge diagnosis of antisocial personality disorder (p < .001) were associated with irregular discharge; the attending psychiatrist was also significant (p = .016). Demographic variables (sex, ethnicity, marital status, religion, employment, education, living circumstances), Axis I diagnosis, and type and number of substances abused were not predictive of discharge type. Patients irregularly discharged within the first week (40% of irregular discharges) were significantly less likely to have known legal involvement (p = .006). No significant temporal clustering of irregular discharges was found on a daily, weekly, or monthly basis, nor was a seasonal pattern detected. These findings are generally consistent with several pre-DSM-III studies on nondual diagnosis units, but more specifically highlight the diagnosis of antisocial personality. Regarding program completion, they suggest that risk factors for irregular discharge (substance abuse, antisocial personality, characteristics of the doctor-patient relationship, problems of younger patients) have not been adequately addressed simply by creating dual diagnosis units. Further programming study appears warranted to address the problem of patient retention on dual diagnosis units.

Generalizing a predictor of male alcoholic treatment outcomes

A predictive index was developed using 34 intake variables from 416 alcoholic inpatient program participants at a Veterans Administration Medical Center (VAMC). Using drinking behavior as the outcome criteria, an R-squared value of 0.562 was achieved and 65% of the index-generating sample was correctly classified. The index was cross-validated on 61 inpatients at 4 months posttreatment. It achieved a point biserial correlation of 0.389 and correctly classified 66% of the sample. The index, unprecedentedly, was generalized to three other VAMCs and achieved an overall r of 0.393 and correctly classified 61% of the generalization subjects.

Staff and patient predictions of success in an inpatient alcohol treatment unit

Staff and patients were overly optimistic in their predictions of abstinence. Staff and patients were equally successful at predicting abstinence. When predictions of abstinence were combined with predictions of nonabstinence, staff predictions were better than patient predictions, probably because patients predicted nonabstinence less frequently.

Factors related to patient attrition from alcoholism treatment programs

This study focused on an examination of a number of factors which might explain dropout from Veterans Administration inpatient alcoholism treatment programs. The investigation included 137 closed treatment groups that were used at this hospital over a 12-year span. These programs involved five different treatment modalities which varied in treatment length as well as in size of the treatment group. Program directors need to be aware that if their treatment approach involves closed treatment groups, the size of the group, its composition, and the length of the program can influence the dropout rate. According to these results the optimal group size is around five individuals and should not include a large percentage of individuals who are of high intelligence. Dropout rates declined as program length was shortened.

Alcohol severity scores of inpatients in treatment vs detoxification programs

Utilizing a severity scale from the Alcohol History Form, 90 patients admitted to an alcohol treatment program were unexpectedly found to have higher scores than 492 patients admitted to a transient detoxification program. The findings, however, are consonant with recent studies suggesting that long stay in alcohol Treatment programs is associated with social and psychological deterioration. The difference in severity scores could not be attributed to differences in “binge” drinking.