Am J Psychiatry 1992; 149:235-239
Copyright © 1992 by American Psychiatric Association
Patients who use drugs during inpatient substance abuse treatment
SF Greenfield, RD Weiss and ML Griffin
Alcohol and Drug Abuse Treatment Center, McLean Hospital, Belmont, Mass.
OBJECTIVE: Drug use by patients during inpatient substance abuse treatment
is frequently a cause of premature hospital discharge. The authors examined
the histories of patients who used drugs while in inpatient substance abuse
treatment, the methods used to detect drug use, and the temporal
relationship of drug use episodes. METHOD: The authors reviewed the charts
of patients admitted consecutively to an inpatient substance abuse
treatment unit between 1981 and 1988. Of 729 patients, 42 were found to
have used drugs while receiving inpatient treatment. The diagnoses and
clinical histories of these 42 patients were compared with those of all
other patients. Methods of detection and circumstances of drug use were
recorded, and drug use episodes were plotted on a time line that was
examined for temporal clustering. RESULTS: Significantly more of the
patients who used drugs during inpatient substance abuse treatment had
primarily used heroin or methadone before treatment. Random urine screens,
self-report, and staff observation together detected approximately 85% of
the patients who used drugs during treatment. Episodes of drug use did
cluster in time, but within clusters the hospital stays of the patients who
used drugs did not necessarily overlap. CONCLUSIONS: Temporal clustering of
drug use episodes may occur because drug use by one patient heralds drug
availability and stimulates craving in other inpatients. Clinicians should
be aware that one episode of drug use may be followed by others. Multiple
detection methods, including random comprehensive urine screens, should be
used to test for drug use on inpatient units.
