Previous comparison studies of inpatient and outpatient forms of treatment for substance dependence have made direct comparisons of the outcomes and costs of these two forms of care under the assumption that both were designed to perform the same rehabilitation function. The present project proposes to compare two groups of 125 cocaine dependent patients randomly assigned to receive either Direct Admission to Intensive Outpatient treatment or to Brief (6-day) Inpatient Stabilization prior to Day Hospital rehabilitation. This study is unlike prior cost effectiveness comparisons because it specifically assumes that inpatient and outpatient treatments should not be evaluated on common outcome criteria. Instead, the study assumes that the appropriate function of inpatient care is to remove the barriers to and prepare the patient for outpatient care. Thus, the outcomes to be compared between the two groups include, engagement, retention and performance in Intensive Outpatient care, post-treatment outcomes as well as the total costs of each type of care. Patients will be evaluated at the start of the study, throughout the course of inpatient and Intensive Outpatient treatment and at six-month follow-up using validated instruments and procedures. All patient and treatment costs in both groups will be measured for comparative analyses. Specific hypotheses are that patients who receive brief stabilization first, will be more likely to engage in outpatient treatment, to complete that treatment and to have better outcomes at follow-up, than those randomly assigned directly to the Intensive Outpatient program. We believe the study is particularly pertinent to contemporary questions of cost, outcome and value in substance abuse treatment.
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