Skip to main content
SpringerLink
Log in

Program characteristics and readmission among older substance abuse patients: Comparisons with middle-aged and younger patients

  • Articles
  • Published:
The journal of mental health administration Aims and scope Submit manuscript

An Erratum to this article was published on 01 December 1996

Abstract

Older substance abuse patients were compared to middle-aged and younger patients before, during, and after an index episode of inpatient care in 1 of 88 substance abuse treatment programs. Associations between program characteristic and readmission rates adjusted for key differences in the types of patients in different programs varied by age group. Among older patients, more structured program policies, more flexible rules about discharge, more comprehensive assessment, and more outpatient mental health aftercare were associated with lower casemix-adjusted readmission rates. More intensive treatment was associated with higher-than-predicted readmission. By contrast, among younger patients, more family involvement in assessment and treatment, community consultation, and treatment emphasizing the development of social and work skills were associated with lower casemix-adjusted readmission rates. The findings suggest that intensive, directed treatment may be more effective for younger substance abuse patients, whereas a more supportive treatment regimen in a well-organized program and prompt outpatient aftercare may be especially helpful for older patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moos R, Mertens JR, Brennan PL: Patterns of diagnosis and treatment among late-middle-aged and older substance abuse patients.Journal of Studies on Alcohol 1993; 54:479–487.

    PubMed  CAS  Google Scholar 

  2. Moos R, Mertens JR, Brennan PL: Rates and predictors of four-year readmission among late-middle-aged and older substance abuse patients.Journal of Studies on Alcohol 1994; 55:561–570.

    PubMed  CAS  Google Scholar 

  3. Finlayson RE, Hurt RD, Davis LJ, et al.: Alcoholismin elderly persons: A study of the psychiatric and psychosocial features of 216 inpatients.Mayo Clinic Proceedings 1988; 63:761–768.

    PubMed  CAS  Google Scholar 

  4. Hurt RD, Finlayson RE, Morse RM, et al.: Alcoholism in elderly persons: Medical aspects and prognoses of 216 inpatients.Mayo Clinic Proceedings 1988; 63:753–760.

    PubMed  CAS  Google Scholar 

  5. Blow FC, Loveland CA, Booth BM, et al.: Age-related psychiatric comorbidities and level of functioning in a coholic veterans seeking outpatient treatment.Hospital and Community Psychiatry 1992; 43:990–995.

    PubMed  CAS  Google Scholar 

  6. Mulford H, Fitzgerald JL: Elderly versus younger problem drinker profiles: Do they indicate a need for special programs for the elderly?Journal of Studies on Alcohol 1992; 53:601–610.

    PubMed  CAS  Google Scholar 

  7. Moos R, Brennan PL, Mertens JR: Diagnostic subgroups and predictors of one-year readmission among late-middle-aged and older substance abuse patients.Journal of Studies on Alcohol 1994; 55:173–183.

    PubMed  CAS  Google Scholar 

  8. Moos R, Finney J, Cronkite R:Alcoholism Treatment: Context, Process, and Outcome. New York: Oxford University Press, 1990.

    Google Scholar 

  9. Ornstein P, Cherepon JA: Demographic variables as predictors of alcoholism treatment outcome.Journal of Studies on Alcohol 1985; 46:425–432.

    PubMed  CAS  Google Scholar 

  10. Fitzgerald JL, Mulford HA: Elderly vs. younger problem drinker “treatment” and recovery experiences.British Journal of Addiction 1992; 87:1281–1291.

    Article  PubMed  CAS  Google Scholar 

  11. Janik SW, Dunham RG: A nationwide examination of the need for specific alcoholism treatment programs for the elderly.Journal of Studies on Alcohol 1983; 44:307–317.

    PubMed  CAS  Google Scholar 

  12. French MT, Zarkin GA, Hubbard RL, et al.: The effects of time in drug abuse treatment and employment on posttreatment drug use and criminal activity.American Journal of Drug and Alcohol Abuse 1993; 19:19–33.

    PubMed  CAS  Google Scholar 

  13. Simpson DD: Treatment for drug abuse: Follow-up outcomes and length of time spent.General Psychiatry 1981; 38:875–880.

    CAS  Google Scholar 

  14. Peterson KA, Swindle RW, Phibbs CS, et al.: Determinants of readmission following inpatient substance abuse treatment: A national study of VA programs.Medical Care 1994; 35:535–550.

    Article  Google Scholar 

  15. Swindle R, Phibbs C, Paradise M, et al.: Inpatient treatment for substance abuse patients with psychiatric disorders: A national study of determinants of readmission.Journal of Substance Abuse 1995; 7:79–97.

    Article  PubMed  CAS  Google Scholar 

  16. Brower KJ, Mudd S, Blow FC: Severity and treatment of alcohol withdrawal in elderly versus younger patients.Alcoholism: Clinical and Experimental Research 1994; 18:196–201.

    Article  CAS  Google Scholar 

  17. Kofoed LL, Tolson RL, Atkinson RM, et al.: Treatment compliance of older alcoholics: An elder-specific approach is superior to “mainstreaming”.Journal of Studies on Alcohol 1987; 48:47–51.

    PubMed  CAS  Google Scholar 

  18. Verinis JS, Foreman RN: Outpatient care participation and six-month status: Results with an impoverished alcoholic veterans population.International Journal of the Addictions 1992; 27:1423–1431.

    PubMed  CAS  Google Scholar 

  19. Siegel C, Alexander MJ, Lin S: Severe alcoholism in the mental health sector. Part 2: Effects of service utilization on readmission.Journal of Studies on Alcohol 1984; 45:510–516.

    PubMed  CAS  Google Scholar 

  20. Walker RD, Donovan DM, Kivlahan DR, et al.: Length of stay, neuropsychological performance, and aftercare: Influences on alcohol treatment outcome.Journal of Consulting and Clinical Psychology 1983; 51:909–911.

    Article  Google Scholar 

  21. Druley KA, Pashko S: Development and evaluation of a treatment program for older veteran alcoholics. In: Gottheil E, Druley KA, Skoloda TE, Waxman HM (Eds.):The Combined Problems of Alcoholism, Drug Addiction and Aging. Springfield, IL: Charles C Thomas, 1985, pp. 336–344.

    Google Scholar 

  22. Dupree LW, Broskowski H, Schonfeld L: Gerontology Alcohol Project: A behavioral treatment program for elderly alcohol abusers.The Gerontologist 1984; 24:510–516.

    PubMed  CAS  Google Scholar 

  23. Kashner TM, Rodell DE, Odgen SR, et al.: Outcomes and costs of two VA inpatient treatment programs for older alcoholic patients.Hospital and Community Psychology 1992; 43:985–989.

    CAS  Google Scholar 

  24. Rice C, Longabaugh R, Beattie M, et al.: Age group differences in response to treatment for problematic alcohol use.Addiction 1993; 88:1369–1375.

    Article  PubMed  CAS  Google Scholar 

  25. Moos R: Assessing the program environment: Implications for program evaluation and design. In: Conrad KJ, Roberts-Gray C (Eds.):New Directions for Program Evaluation: Evaluating Program Environments. San Francisco: Jossey-Bass, 1988, pp. 7–23.

    Google Scholar 

  26. McGaughrin WC, Price PH: Effective outpatient drug treatment organizations: Program features and selection effects.International Journal of the Addictions 1992; 27:1335–1357.

    Google Scholar 

  27. Hellman I, Greene L, Morrison T, et al.: Organizational size and perception in a residential treatment program.American Journal of Community Psychology 1985; 13:99–109.

    Article  PubMed  CAS  Google Scholar 

  28. Leda C, Rosenbeck R, Fontana A: Impact of staffing levels on transitional residential treatment programs for homeless veterans.Psychosocial Rehabilitation Journal 1991; 15:55–67.

    Google Scholar 

  29. Atkinson RM, Tolson RT, Turner JA: Factors affecting outpatient treatment compliance of older male problem drinkers.Journal of Studies on Alcohol 1993; 54:102–106.

    PubMed  CAS  Google Scholar 

  30. Bale R, Zarcone V, Van Stone W, et al.: Three therapeutic communities: Process and outcome in a prospective controlled study of narcotic addiction treatment.Archives of General Psychiatry 1984; 41:185–191.

    PubMed  CAS  Google Scholar 

  31. Moos R:Community-Oriented Program Environment Scale Manual. Second ed. Palo Alto, CA: Mind Garden, 1988.

    Google Scholar 

  32. Moos R:Ward Atmosphere Scale Manual. Second ed. Palo Alto, CA: Mind Garden, 1989.

    Google Scholar 

  33. Collins J, Ellsworth R, Casey N, et al.: Treatment characteristics of psychiatric programs that correlate with patient community adjustment.Journal of Clinical Psychology 1985; 41:299–308.

    PubMed  CAS  Google Scholar 

  34. International Classification of Diseases. Ninth rev.Clinical Modification ICD-9-CM. Vols 1–3. Ann Arbor, MI: Commission on Professional and Hospital Activities, 1986.

  35. Peterson KA, Swindle RW, Paradise M, et al.:Substance Abuse Treatment Programming in the Department of Veterans Affairs: Staffing, Patients, Services, and Policies. Palo Alto, CA: Program Evaluation and Resource Center and Center for Health Care Evaluation, Department of Veterans Affairs Medical Center, 1993.

    Google Scholar 

  36. Timko C: Policies and services in residential substance abuse programs: Comparisons with psychiatric programs.Journal of Substance Abuse 1995; 7:43–59.

    Article  PubMed  CAS  Google Scholar 

  37. Swindle RW, Peterson KA, Paradise M, et al.: Measuring program treatment orientations: The Drug and Alcohol Program Treatment Inventory.Journal of Substance Abuse 1995; 7:61–77.

    Article  PubMed  CAS  Google Scholar 

  38. Corten M, Ribourdille M, Herman P: Epidemiological survey of the “natural” mortality in psychiatry.Acta Psychiatrica Belgique 1988; 88:349–371.

    CAS  Google Scholar 

  39. Moos R, Moos B: Stay in residential facilities and mental health care as predictors of readmission for patients with substance use disorders.Psychiatric Services 1995; 46:66–72.

    PubMed  CAS  Google Scholar 

  40. Friis S: Characteristics of a good ward atmosphere.Acta Psychiatrica Scandinavica 1986; 74:469–473.

    PubMed  CAS  Google Scholar 

  41. Schutte KK, Brennan PL, Moos RH: Remission of late-life drinking problems: A four-year follow-up.Alcoholism: Clinical and Experimental Research 1994; 18:835–844.

    Article  CAS  Google Scholar 

  42. Graham K, Saunders S, Flower M, et al.: Addiction treatment for older adults: Evaluation of an innovative client-centered approach. New York: Haworth, 1994.

    Google Scholar 

  43. Axelrod S, Wetzler S: Factors associated with better compliance with psychiatric aftercare.Hospital and Community Psychiatry 1989; 40:397–401.

    PubMed  CAS  Google Scholar 

  44. Verinis JS, Taylor J: Increasing alcoholic patient’s aftercare attendance.International Journal of the Addictions 1994; 29:1487–1494.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Health Care Evaluation (152), Department of Veterans Affairs and Stanford University Medical Centers, 3801 Miranda, 94304, Palo Alto, CA

    Rudolf H. Moos Ph.D. (research career scientist), Jennifer R. Mertens M.A. (social science research assistant) & Penny L. Brennan Ph.D. (health science specialist)

Authors
  1. Rudolf H. Moos Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer R. Mertens M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Penny L. Brennan Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

The authors are also affiliated with the Program Evaluation and Resource Center at the Department of Veterans Affairs.

An erratum to this article is available at http://dx.doi.org/10.1007/BF02518653.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moos, R.H., Mertens, J.R. & Brennan, P.L. Program characteristics and readmission among older substance abuse patients: Comparisons with middle-aged and younger patients. The Journal of Mental Health Administration 22, 332–345 (1995). https://doi.org/10.1007/BF02518628

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02518628

Keywords

Search

Navigation