The journal of mental health administration

, Volume 23, Issue 2, pp 234–245

Day versus inpatient treatment for cocaine dependence: An experimental comparison

  • Rob Schneider
  • Cynthia Mittelmeier
  • Daniel Gadish


This study was designed to explore the question of whether day treatment is a viable alternative to inpatient treatment for cocaine-dependent patients. Inpatient subjects were compared with day-treatment subjects in a randomized, prospective study design. Treatment outcome was evaluated at three and six months posttreatment. At three months posttreatment, the inpatient group had a statistically significant higher rate of total abstinence than the day-treatment group, but the difference at six months was not statistically significant. The two groups also were statistically comparable at six months posttreatment in terms of “current” abstinence and in terms of other measures. Average costs for day-treatment subjects was 48–61% of the cost for inpatient subjects. The results of this study support the use of day treatment as a clinically and economically effective alternative to inpatient treatment for many cocaine-dependent patients, especially when steps are taken to minimize drop out.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Institute of Medicine:Prevention and Treatment of Alcohol Problems. Washington, DC: National Academy Press, 1989.Google Scholar
  2. 2.
    Miller WR, Hestor RK: Inpatient alcoholism treatment: Who benefits?American Psychologist 1986; 41: 794–805.PubMedCrossRefGoogle Scholar
  3. 3.
    Seventh Special Report to the U.S. Congress on Alcohol and Health. DHHS Publ. No. (ADM) 90-1656. Washington, DC: National Institute of Alcohol Abuse and Alcoholism, 1990.Google Scholar
  4. 4.
    Office of Technology Assessment.The Effectiveness and Costs of Alcoholism Treatment. Washington, DC: Office of Technology Assessment, 1983.Google Scholar
  5. 5.
    Institute of Medicine:Treating Drug Problems. Washington, DC: National Academy Press, 1990.Google Scholar
  6. 6.
    Institute of Medicine:Broadening the Base of Treatment for Alcohol Problems. Washington, DC: National Academy Press, 1990.Google Scholar
  7. 7.
    Miller WR: Emergent treatment concepts and techniques.Annual Review of Addictions Research and Treatment 1991; 1:1–14.Google Scholar
  8. 8.
    Fink EB, Longabaugh R, McCrady BM, et al.: Effectiveness of alcoholism treatment in partial versus inpatient settings: Twenty-four month outcomes.Addictive Behaviors 1985; 10:235–248.PubMedCrossRefGoogle Scholar
  9. 9.
    Longabaugh R, McCrady B, Fink E: Cost-effectiveness of alcoholism treatment in partial vs inpatient settings: Six month outcomes.Journal of Studies on Alcohol 1983; 44:1049–1071.PubMedGoogle Scholar
  10. 10.
    McLachlan J, Stein R: Evaluation of a day treatment for alcoholicsJournal of Studies on Alcohol 1982; 43:261–272.PubMedGoogle Scholar
  11. 11.
    Schneider RJ, Googins B: Alcoholism day treatment: Rationale, research and resistance.Journal of Drug Issues 1989; 9:437–449.Google Scholar
  12. 12.
    Alterman AL, O’Brien CP, McLellan AT, et al.: Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation.Journal of Nervous and Mental Disorders, in press.Google Scholar
  13. 13.
    Walsh DC, HIngson RW, Merrigan DM, et al.: A randomized trial of treatment options for alcohol-abusing workers.New England Journal of Medicine 1991; 325:775–782.PubMedCrossRefGoogle Scholar
  14. 14.
    Cohen J:Statistical power analysis for the behavioral sciences. Rev. ed. New York: Academic Press, 1977.Google Scholar
  15. 15.
    McLellan AT, Luborsky L, O’Brien CP, et al.: An improved evaluation instrument for substance abuse patients: The Addiction Severity Index.Journal of Nervous and Mental Disorders 1980; 168:26–33.CrossRefGoogle Scholar
  16. 16.
    McLellan AT, Luborsky L, Cacciola J et al.: New data from the Addiction Severity Index: Reliability and validity in three centers.Journal of Nervous and Mental Disorders 1985; 173:412–423.Google Scholar
  17. 17.
    Sutton SR: Interpreting relapse curves.Journal of Consulting and Clinical Psychology. 1979; 47:96–98.PubMedCrossRefGoogle Scholar
  18. 18.
    Fureman B, Parikh G, Bragg A, et al: Addiction Severity Index—A guide to training and supervising ASI interviews. Fifth ed. Unpublished manuscript, University of Pennsylvania, 1990.Google Scholar
  19. 19.
    Schneider RJ, Herbert M: Substance abuse day treatment and managed health care.Journal of Mental Health Administration 1992; 19:119–124.PubMedGoogle Scholar
  20. 20.
    McGuire T, Frisman L: Reimbursement policy and cost-effective mental health care.American Psychologist 1983; 38(8):935–940.PubMedCrossRefGoogle Scholar
  21. 21.
    Babor T, Stephens R, Marlatt GA: Verbal report methods in clinical research on alcoholism: Response bias and its minimization.Journal of Studies on Alcohol 1987; 48:410–424.PubMedGoogle Scholar
  22. 22.
    McLellan AT, Luborsky L, O’Brien CP, et al.: Is treatment for substance abuse effective?Journal of the American Medical Association 1982;247:1423–1428.PubMedCrossRefGoogle Scholar
  23. 23.
    Smith J, Frawley J: Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program.Journal of Substance Abuse Treatment 1990; 7:77–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Sobell LC, Maisto SA, Sobell MB, et al. Reliability of alcohol abusers’ self-reports of drinking behavior.Behavior Research and Therapy 1979; 17:157–160.CrossRefGoogle Scholar
  25. 25.
    Harrell AV:Validation of self-report: The research record. National Institute on Drug Abuse Research Monograph 57. Rockville, MD: Department of Health and Human Services, 1985, pp. 12–21.Google Scholar
  26. 26.
    Nurco DN: A discussion of validity. In: Rouse BA, Kozel NJ, Richards LG (Eds.):Self-Report Methods of Estimating Drug Use: Meeting Current Challenges to Validity. National Institute on Drug Abuse Research Monograph 57. Rockville, MD: National Institute on Drug Abuse, 1985, pp. 4–11.Google Scholar

Copyright information

© Association of Mental Health Administrators 1996

Authors and Affiliations

  • Rob Schneider
    • 1
  • Cynthia Mittelmeier
    • 1
  • Daniel Gadish
    • 1
  1. 1.Psychologist/Coordinator of Substance Abuse ServicesBraintree Center of Harvard Community Health PlanBraintree

Personalised recommendations