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Chapter 31. Inpatient Treatment

Roger D. Weiss, M.D.; Jennifer Sharpe Potter, Ph.D., M.P.H.; Rocco A. Iannucci, M.D.
DOI: 10.1176/appi.books.9781585623440.359576

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In recent years, few subjects in the field of addiction research have generated as much debate as the role of inpatient treatment for patients with substance use disorders (SUDs). This controversy has been fueled in part by the enormous cost of SUD treatment in the United States: in 2005, the direct cost for their treatment was estimated at $18 billion (Mark et al. 2005). In contrast, the annual cost to society of alcohol- and drug-related problems has been estimated to be more than $410 billion (Mojtabai and Zivin 2003). Therefore, establishing effective treatment methods for patients with SUDs is both a public health and a financial priority. Because the resources available to tackle this issue are finite, treatment should be not only effective but also cost-effective. While the treatment of SUDs overall has a favorable cost-benefit ratio compared with other medical care, questions have been raised about the cost-effectiveness of inpatient treatment for substance-related problems (Mojtabai and Zivin 2003). Because the cost differential between inpatient and outpatient treatment is substantial, and because there is wide variation in per diem costs even among inpatient facilities, determining the proper role of hospital treatment is critical.

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Table Reference Number

Inpatient treatment programs for substance use disorders (SUDs) are heterogeneous, taking place in an array of facilities with different theoretical orientations, planned durations, and immediate treatment goals (i.e., detoxification, formal rehabilitation, or both).

Inpatient treatment of SUDs is indicated for particular patients unlikely to benefit sufficiently from less intensive levels of care. This may include patients with severe SUDs, co-occurring psychiatric problems, or medical complications that are best managed in an inpatient setting. Clinical guidelines have been developed to assist clinicians in determining the appropriate level of care.

The evolving understanding of risk factors for poor outcomes from inpatient care can help clinicians to identify patients who may need additional interventions or who may be best treated in other settings.

Emerging knowledge about program elements most likely to benefit specific groups of patients can inform clinicians in optimizing the care provided in inpatient/residential programs.

More research is needed, particularly on identifying which subgroups of patients are most likely to benefit from inpatient treatment, as well as on how inpatient care best fits into the full continuum of treatment levels.

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Sample questions:
1.
The Minnesota Model of inpatient substance abuse treatment is one of the more common inpatient models in practice in the United States. Which of the following statements about this treatment model is false?
2.
Often, the decision whether to treat a substance abuse patient on an inpatient model is facilitated by the application of placement criteria pertinent to inpatient care. One such useful set of guidelines has been produced by the American Society of Addiction Medicine (ASAM). Which of the following is not one of the areas to be assessed according to these criteria?
3.
Studies comparing substance abuse inpatients and outpatients have shown inpatients to have lower levels of which of the following?
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