Improving Entry into Post-Detoxification Treatment

Although inpatient detoxification for substance use disorders improves outcomes in the short term, long-term outcomes are poor. A substantial minority of patients don't complete detoxification, and those that do complete it rarely enroll in post-detoxification treatment.

This study describes outcomes for the Intensive Treatment Unit (ITU), a brief inpatient detoxification program that includes linking patients with treatment. Staffed by an attending psychiatrist and a team of nurses, length of stay ranges from 3–4 days and includes pharmacotherapy and group therapy run by the nursing staff. Most patients are admitted for heroin, cocaine, or alcohol detoxification. Strategies to increase attendance in aftercare programs include involving the patients in their own discharge planning, escort to post-detoxification programs for the initial visit, and provision of transportation. Follow-up of 134 ITU patients was conducted at 1 month. Seventy-eight percent of patients were male, 73% were African American, 95% were unemployed, and 61% were homeless.

• Of the 123 patients discharged from detoxification with a treatment plan, 83% entered treatment. Successful entry was more likely with long-term residential facilities (99%) and recovery houses (96%) compared with outpatient programs (55%).

Comments by Tom Delaney, MSW, MPA
Although this study reports hopeful results, with most clients moving on to other substance abuse treatment services after detoxification, the applicability of these findings is questionable because of differing definitions of detoxification among states, insurance carriers, and accrediting bodies. Also, patients at high risk for complicated withdrawal were referred to detoxification units with longer lengths of stay, and their absence from the study sample may have affected results. Nonetheless, the high rate of successful referrals encourages development of specific follow-up plans for detoxification patients.