IRREGULAR DISCHARGES FROM A DUAL DIAGNOSIS UNIT

Irregular discharges, previously studied on psychiatric or substance a buse treatment units, are a particular problem for dual diagnosis unit s. We examined demographic and clinical variables for their associatio n with irregular discharge from an acute dual diagnosis inpatient unit , retrospectively reviewing 316 consecutive admissions. One hundred an d nineteen patients (37.7%) were irregularly discharged (61 AMA, 31 ad ministrative, 27 elopements), staying an average of 18.8 days compared with 51.4 days for those regularly discharged (p <.001). Younger age (p = .007) and discharge diagnosis of antisocial personality disorder (p <.001) were associated with irregular discharge; the attending psyc hiatrist was also significant (p = .016). Demographic variables (sex, ethnicity, marital status, religion, employment, education, living cir cumstances), Axis I diagnosis, and type and number of substances abuse d were not predictive of discharge type. Patients irregularly discharg ed within the first week (40% of irregular discharges) were significan tly less likely to have known legal involvement (p = .006). No signifi cant temporal clustering of irregular discharges was found on a daily, weekly, or monthly basis, nor was a seasonal pattern detected. These findings are generally consistent with several pre-DSM-III studies on nondual diagnosis units, but more specifically highlight the diagnosis of antisocial personality. Regarding program completion, they suggest that risk factors for irregular discharge (substance abuse, antisocia l personality, characteristics of the doctor-patient relationship, pro blems of younger patients) have not been adequately addressed simply b y creating dual diagnosis units. Further programming study appears war ranted to address the problem of patient retention on dual diagnosis u nits.