Treatment Settings for Alcoholics: A Field Extension

DESCRIPTION (provided by applicant): This health services application is a field replication and extension of our prior work evaluating treatment settings for alcoholics. Our prior research, conducted in a clinical research environment, found that individuals with a more severe problem benefited more from inpatient than outpatient treatment. For all clients, in patient treatment, relative to outpatient, resulted in fewer combined days of residential treatment or incarceration throughout the 18 month follow-up. These findings are important since inpatient care is becoming increasingly scarce due to the perception that less expensive outpatient treatment is equally effective for all individuals. Moreover, in the absence of empirically-derived placement criteria, level of care determinations often appear circular and inefficient (i.e., to enter inpatient treatment one has to fail outpatient first). Our findings suggest that more efficient level of care determinations may be possible. To address these issues further, we propose to test our earlier findings in a community field setting by prospectively matching and mismatching clients based on alcohol involvement level and/or level of cognitive functioning to either inpatient or outpatient care. Clients presenting for treatment at the Downtown Clinic of the Erie County Medical Center (ECMC), Buffalo, NY will be assigned to inpatient need group (based on alcohol involvement and cognitive functioning levels) and, within each group, randomly assigned to either (a) 21 days of inpatient care at ECMC plus six months of continuing outpatient care. Treatment will be the standard treatment received by clients in the respective programs. All clients will be followed over 18 months following admission (12 months post-continuing outpatient care) and evaluated with respect to the primary outcome measures of voluntary abstinent days and days of involuntary abstinence (i.e., incarceration, residential treatment, etc.). Building on our prior work, the proposal aims to contribute to a small but important body of knowledge on efficient and effective client placement criteria.