Inpatient treatment for patients with substance use disorders: outcomes at 6 months follow-up for both voluntarily and compulsorily admitted patients

Abstract

Many patients seeking inpatient treatment for substance use disorders have high levels of severity and often have comorbid mental illness, which can complicate the course of treatment. Up-to-date treatment approaches include the aim of reducing the symptom burden and avoiding further deterioration. Subsequently, treatment services need to incorporate multi-dimensional and patient-oriented measures of disease burden, such as quality of life and psychological wellbeing measures. This thesis investigated the outcomes at six months follow-up in a cohort of adults who received inpatient treatment within specialist treatment service for addictive disorders. The patient population included both voluntarily admitted as well as compulsorily admitted patients, pursuant to the Norwegian Municipal Health Care Act. The results showed modest improvements in quality of life and substance-use related outcomes at six months following inpatient treatment for both groups of patients. Abstinence at follow-up was not a predictor for large improvements in quality of life. Inpatient treatment reduced mental distress for both groups. At follow-up, the voluntary admitted patients maintained their improvement, whereas the compulsory admitted patients returned to levels similar to pre-treatment. Relapse following discharge from treatment may explain the setback in mental distress. Severity of the substance use disorder seemed a more important predictor for outcomes than type of treatment admission (voluntary vs compulsory). The findings suggest that treatment outcomes and rehabilitation should be seen as a more complex process than simply an altered pattern of substance use. This raises issues about the importance of more formal aftercare provision following discharge from specialized services. Additionally, repeated monitoring of outcomes such as quality of life and mental distress can be applied in repeated evaluations of SUD treatment to guide and target treatment interventions, and thus, facilitating entry into a corresponding level of care in the treatment system.