Am J Psychiatry 1992; 149:1212-1218
Copyright © 1992 by American Psychiatric Association
An evaluation of the Cleveland criteria for inpatient treatment of substance abuse
JR McKay, AT McLellan and AI Alterman
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia.
OBJECTIVE: This study examined the validity of the Cleveland Admission,
Discharge, and Transfer Criteria, a comprehensive system for assigning
alcohol- and drug-abusing patients to appropriate levels of care. METHOD:
The subjects were 143 alcoholic and cocaine-dependent male patients in an
intensive Veterans Administration day treatment program for substance
abusers. Patients who should have received inpatient treatment according to
the Cleveland criteria were compared with those who were properly "matched"
to day treatment according to the criteria. The outcome measures were
treatment completion, results of urine toxicology screens, and self-reports
of substance use and psychosocial functioning. RESULTS: Patients who met
the criteria for inpatient care were not more likely to drop out of day
hospital treatment, and there was no evidence that they were drinking or
using cocaine more frequently during follow-up. Furthermore, they did not
appear to be doing worse on any of the other outcome measures, with the
exception of psychological status. CONCLUSIONS: The results suggest that
for male substance abusers in the lower socioeconomic levels, the Cleveland
criteria may not be effective in differentiating patients who can manage
well with day hospital treatment and those who require inpatient treatment.
