Six-month outcomes of hospital-based psychiatric substance use consultations

Substance use disorders and their health complications are prevalent in general hospitals. Among intervention measures, specialized substance use consultations by a general hospital psychiatric consultation team have been described. Because outcome data are scanty, effectiveness of specialist consultations is not known. To analyze effectiveness of focused, semistructured consultations by clinically competent consultants, we conducted a prospective 6-month follow-up in a hospital-based psychiatric substance use consultation service. We aimed to measure severity of dependence and changes in substance use and to find out which variables at the consultation anticipated abstinence or reduction in substance use. Among general hospital patients referred for substance use consultation, 30% (46/155) of the male patients and 56% (35/63) of the female patients reported either abstinence or reduction in substance use at the 6-month follow-up. Changes in weekly alcohol consumption and SADD (Short Alcohol Dependence Data) scores were statistically significant (P<0.001) and clinically highly meaningful. Absence of earlier psychiatric or substance use treatment and fewer adverse substance use consequences predicted reduction in substance use. Compliance and outcomes were remarkable among female patients, and improvement was promoted by unbroken family relations. In all, hospital-based psychiatric substance use consultations seemed to be effective as the only treatment among socially adjusted substance use patients, whereas patients with psychiatric comorbidity and/or chronic substance use problems needed more vigorous help.