Abstract
Miller and Hester's 1986 review of inpatient versus outpatient alcohol treatment studies concluded with no “justification” for inpatient treatment. Further examination of these studies revealed shortcomings such as the use of random assignment designs which excluded psychiatrically-complicated patients. Carrier Foundation's inpatient/outpatient study of private psychiatric patients with alcohol and/or cocaine dependence includes a patient-treatment matching design to address weaknesses in the existing literature. Patients with high psychiatric severity and/or a poor social support system are predicted to have a better outcome in inpatient treatment, while patients with low psychiatric severity and/or a good social support system may do well as outpatients without incurring the higher costs of inpatient treatment. Preliminary results from 183 inpatients and 120 outpatients indicated outpatients, regardless of level of psychiatric severity, were 4 times more likely to be early treatment failures (chi-square=41.2,df=1,p<.01). While the determination of long-term follow-up status of early treatment failures is currently underway, this finding underscores the potential risk of early treatment failure in outpatient compared to inpatient substance abuse treatment programs and the importance of addressing the issue of early attrition in conducting outcome analyses.
Similar content being viewed by others
References
Culhane C: Betty Ford: Stop punishing drug addicts. U.S. Journal of Drug and Alcohol Dependence 15(6):3, 1991.
Walsh DC, Hingson RW, Merrigan DM, et al: A randomized trial of treatment options for alcohol-abusing workers. The New England Journal of Medicine 325: 775–782, 1991.
Miller WR, Hester RK: Inpatient alcoholism treatment: Who benefits? American Psychologist 41:794–805, 1986.
Chernus LA: Clinical issues in alcoholism treatment. Social Casework: Journal of Contemporary Social Work 66:67–75, 1985.
Eriksen L: The effect of waiting for inpatient alcoholism treatment after detoxification: An experimental comparison between inpatient treatment and advice only. Addictive Behaviors 11:389–397, 1986.
Edwards G, Orford J, Egert S, et al: Alcoholism: A controlled trial of “treatment” and “advice.” Journal of Studies on Alcohol 38:1004–1031, 1977.
Stein LI, Newton JR, Bowman RS: Duration of hospitalization for alcoholism. Archives of General Psychiatry 32:247–253, 1975.
Kissin B, Platz A, Su WH: Social and psychological factors in the treatment of chronic alcoholism. Journal of Psychiatric Research 8:13–27, 1970.
Gallant DM, Bishop MP, Mouledoux A, et al: The revolving-door alcoholic: An impasse in the treatment of the chronic alcoholic. Archives of General Psychiatry 28:633–635, 1973.
Wallace J: Inpatient and outpatient care: A balanced perspective. NAATP Review July/August:18–21, 1989.
Edwards G, Guthrie S: A controlled trial of inpatient and outpatient treatment of alcohol dependency. Lancet 1:555–559, 1967.
Wilson A, White J, Lange DE: Outcome evaluation of a hospital-based alcoholism treatment programme. British Journal of Addiction 73:39–45, 1978.
Smart RG, Finley J, Funston, R: The effectiveness of post-detoxification referrals: Effects on later detoxification admissions, drunkenness and criminality. Drug and Alcohol Dependence 2:149–155, 1977.
Backland F, Lundwall L: Dropping out of treatment: A critical review. Psychological Bulletin 82:738–783, 1975.
Mattson ME, Allen JP: Research on matching alcoholic patients to treatments: Findings, issues, and implications. Journal of Addictive Diseases 11(2):33–49, 1991.
McLellan AT, Luborsky L, O'Brien CP, et al: Is treatment for substance abuse effective? Journal of the American Medical Association 241:1423–1428, 1982.
McLellan AT, Woody GE, Luborsky L, et al: Increased effectiveness of substance abuse treatment: A prospective study of patient-treatment “matching.” Journal of Nervous and Mental Disease 171:597–605, 1983.
Derogatis LR: SCL-90 administration scoring and procedures manual-I for the revised version. Baltimore, Johns Hopkins University School of Medicine, 1978.
Rounsaville BJ, Dalinsky ZS, Babor TF, et al: Psychopathology as a predictor of treatment outcome in alcoholics. Archives of General Psychiatry 44:505–513, 1987.
Woody GE, McLellan AT, Luborsky L, et al: Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: The Veterans Administration-Penn Study. American Journal of Psychiatry 141:1172–1179, 1984.
McLellan AT, Luborsky L, Woody GE, et al: An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease 168:26–33, 1980.
Selzer ML: The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument. American Journal of Psychiatry 127:1653–1658, 1972.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pettinati, H.M., Meyers, K., Jensen, J.M. et al. Inpatient vs outpatient treatment for substance dependence revisited. Psych Quart 64, 173–182 (1993). https://doi.org/10.1007/BF01065868
Issue Date:
DOI: https://doi.org/10.1007/BF01065868