THE EFFECTIVENESS OF INPATIENT AND OUTPATIENT TREATMENT FOR ALCOHOL-ABUSE - THE NEED TO FOCUS ON MEDIATORS AND MODERATORS OF SETTING EFFECTS

Previous reviews have concluded that there was no evidence for the sup eriority of inpatient over outpatient treatment of alcohol abuse, alth ough particular types of patients might be more effectively treated in inpatient settings. In this review, we first consider the conceptual rationales that have been offered to support inpatient and outpatient treatment Following that, the results of the relevant research on sett ing effects are presented. Five studies had significant setting effect s favoring inpatient treatment, two studies found day hospital to be s ignificantly more effective than inpatient treatment, and seven studie s yielded no significant differences on drinking-related outcome varia bles. In all but one instance in which a significant effect emerged, p atients in the 'superior' setting received more intensive treatment an d patients were not 'preselected' for their willingness to accept rand om assignment to treatment in either setting. Studies finding signific ant setting effects also conducted more treatment contrasts (18.6 vs. 4.9), on average, and had a mean statistical power level of 0.71 (medi an 0.79) to detect a medium-sized effect, whereas studies with no sign ificant findings had an average power level of 0.55 (median 0.57). Whe n inpatient treatment was found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion c riteria and to use random assignment to treatment settings. We conside r the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents o f inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.