Inpatient Care Best for Suicidal Drug Abusers

NEW YORK (Reuters Health) - A considerable number of individuals with substance-abuse disorders attempt suicide and a new study shows that they are likely to benefit more from inpatient care than from treatment provided on an outpatient basis.

In a recent study, suicidal patients receiving inpatient as opposed to outpatient substance abuse treatment had better substance-related but not psychiatric-related outcomes following treatment.

A recent suicide attempt may reflect the severity of substance abuse, Dr. Mark A. Ilgen and colleagues offer in the journal Alcoholism: Clinical and Experimental Research.

It could also be that suicidality is "an indicator of motivation, a readiness to change, so that someone who enters treatment after a suicide attempt may be particularly motivated to do something about their substance use disorder," Ilgen explained in an interview with Reuters Health.

"So if they can get into a sufficiently intensive setting where they can have some residential stability and intense enough treatment, then they can act on that higher motivation," he said.

For their study, Ilgen and his colleagues at the Stanford University School of Medicine in Menlo Park, California, followed up on a national sample of 1289 patients treated at 51 VA substance use treatment programs. The rate of recent suicide attempts was 4 percent.

Subjects who reported a recent suicide attempt and were treated as inpatients had better outcomes at 6 months than did suicidal patients treated as outpatients and nonsuicidal patients. They had significantly less drug use and fewer related problems, the authors report.

"Historically, substance-abuse treatment was usually provided in inpatient settings," Ilgen said in a statement. But during the last few years, there has been a push to expand treatment options into more outpatient settings, largely to contain costs. The current study suggests that, at least for suicidal patients, this is not the best approach.

SOURCE: Alcoholism: Clinical and Experimental Research, Sept. 2005.