Am J Psychiatry 1992; 149:810-815
Copyright © 1992 by American Psychiatric Association
Crack/cocaine abusers in the general hospital: assessment and initiation of care
M Galanter, S Egelko, G De Leon, C Rohrs and H Franco
Department of Psychiatry, New York University School of Medicine, NY 10016.
OBJECTIVE: Cocaine, either smoked (as "crack") or taken intranasally, is
now a common cause of psychiatric illness. This study was designed to
assess the impact of cocaine abuse on a general psychiatric service and an
obstetrics service in an urban general hospital and to evaluate a program
for engaging affected patients in addiction treatment. METHOD: The charts
of 300 general psychiatric patients (not admitted for addiction treatment)
and 60 cocaine-abusing prenatal or postpartum patients were reviewed. A
treatment referral program based on professionally directed peer leadership
was established for patients with cocaine abuse. Results of evaluation and
referral of 100 other cocaine-abusing psychiatric patients and the 60
prenatal or postpartum patients were then determined. RESULTS: Fully 64% (N
= 191) of the 300 psychiatric patients were diagnosed as substance abusers;
38% (N = 113) of them abused cocaine. Almost one-third of these cocaine
abusers had no axis I diagnosis other than substance abuse/dependence, and
the majority were homeless. Urine samples were positive for cocaine in a
majority of the obstetric patients studied. A majority of the psychiatric
patients who were referred through the peer-led program enrolled in
outpatient cocaine treatment--three times as many as in the chart review
group. Most of the obstetric patients suitable for referral enrolled for
treatment as well. CONCLUSIONS: Cocaine abuse may be responsible for a
large portion of psychiatric admissions in urban public general hospitals.
Cocaine abusers in psychiatric and obstetrics services are apparently
responsive to a peer-oriented mode of referral into treatment.
