Inpatient care still important
Outpatient alcoholism treatment doesn't work for everyone

By KATHLEEN WEAVER
Reporter Contributor

A study of treatment settings for persons with alcohol-abuse problems has shown that while outpatient care can help many, inpatient programs may be the preferred treatment setting for individuals with more severe alcohol problems and/or cognitive impairment.

According to Robert G. Rychtarik, efforts to cut health-care costs and prior research suggesting no differences between inpatient and outpatient treatment have resulted in a sharp reduction in the availability of inpatient alcoholism treatment and an increase in outpatient care for those with drinking problems.

But a study conducted by Rychtarik, who headed a team of researchers at UB's Research Institute on Addictions studying treatment settings for persons with alcohol problems and evaluating which individuals benefit most from them, shows there still is a place for inpatient treatment.

Rychtarik's research was funded with $788,000 in grants from the National Institute on Alcohol Abuse and Alcoholism.

In a report published in the April issue of the Journal of Consulting and Clinical Psychology, Rychtarik and colleagues randomly assigned groups of alcoholics to 28 days of either inpatient, intensive outpatient, or less-intensive standard outpatient treatment. Clients in all treatment settings were scheduled for an additional six months of outpatient aftercare following their assigned treatment and were followed by the researchers across 18 months post-treatment.

"Averaged across client characteristics, we found significant improvement among clients in all treatments, but no overall difference between inpatients, intensive outpatients or standard outpatients," according to Rychtarik.

"However, when we took individual client characteristics into account, clients with more severe drinking problems were found to have a higher percentage of days of voluntarily abstinent-abstinent days not restricted due to hospitalization or incarceration-and to average lower amounts of alcohol consumption per drinking day when treated as inpatients than when treated as either intensive or standard outpatients.

"On the other hand, those low in drinking-problem severity benefited most from outpatient care, regardless of intensity. Clients in the mid-range of problem severity benefited equally well across the three treatments."

The research also suggested that individuals with cognitive impairment-showing signs of potential brain damage-benefited more from inpatient than outpatient care. Those in the mid- to high-range of cognitive functioning benefited equally well from the three settings.

"A noteworthy finding," Rychtarik said, "was that while general drinking outcomes were similar across settings, during the follow-up inpatients spent fewer days incarcerated and/or in residential substance-abuse treatment combined than either intensive or standard outpatients. The finding suggests that cost savings from outpatient care may be offset to some extent by higher costs of readmissions and incarcerations following treatment."

Rychtarik also noted that, "the two outpatient settings were similar on all the outcome measures and did not vary according to either client problem severity or cognitive functioning, furthering support for the notion that intensity of outpatient treatment may be less important than once thought."

The results of this research may be helpful to alcoholism treatment professionals who make decisions about clients' level of care, and to policymakers responsible for establishing clinical-care guidelines for alcoholism treatment. The researchers noted that future research needs to examine the cost-effectiveness of alcoholism-treatment settings replicate the findings across different sites, explore factors accounting for the current results and examine the findings when newer medications for relapse prevention are part of the treatment plan.

Gerard J. Connors, Robert B. Whitney, Neil B. McGillicuddy, James M. Fitterling and Philip W. Wirtz also contributed to the study.