Abstract
Objectives: Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this study as well as explore possible associations between clinical/demographic factors and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates. Methods: In this retrospective study, medical records of all patients admitted to the unit between January 1, 2012, and July 1, 2013, were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson's chi-squared test and binary logistic regression. Results: Patients admitted to our unit were affected by schizophrenia (31.8%), personality disorder (25%), and depression (18.3%). Substances in use included alcohol (67.5%), cannabis (8.35%), and benzodiazepines (9%). Almost half of the patients were polysubstance users (48.9%). The unit had high rates of immigrants, mainly ex-USSR- and Ethiopian-born. It had low rates of individuals who had served in the army (52.8%), despite the service being mandatory in Israel. Sixty-eight percent of patients completed the program as planned, and 32% were discharged early: 8.6% discharged due to drug use in detoxification settings, violence, or hospitalization for clinical reasons and 23.2% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7% of patients with severe mental illness, 44.3% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found that patients with disability pensions (odds ratio [OR] = 0.36; 95% confidence interval [CI] [0.14–0.91]; p =.03) and polysubstance use (OR = 0.39; 95% [CI] [0.23, 0.66], p <.001) had a higher risk of early discharge. Upon completion of individual programs, 52% were referred to an ambulatory addiction center and 13% to a nationally sponsored dual diagnosis therapeutic community.Conclusions: Israel's single official dual diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. A suboptimal treatment regimen may contribute to the early discharge of patients with polysubstance use and diagnosed personality disorders. An association between early discharges and a disability pension warrant further investigation, as there is no apparent connection between the two.
Original language | English |
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Pages (from-to) | 137-147 |
Number of pages | 11 |
Journal | Journal of Dual Diagnosis |
Volume | 14 |
Issue number | 3 |
DOIs | |
State | Published - 3 Jul 2018 |
Keywords
- Army service
- Ethiopian immigrants
- Israel national insurance institute
- Russian immigrants
- personality disorder
- polysubstance use
- schizophrenia
- severe mental illness
ASJC Scopus subject areas
- Psychiatry and Mental health