COMPARATIVE OUTCOMES AND COSTS OF INPATIENT CARE AND SUPPORTIVE HOUSING FOR SUBSTANCE-DEPENDENT VETERANS

Objective: This study examined the differential effectiveness and cost s of three weeks of treatment for patients with moderately severe subs tance dependence assigned to inpatient treatment or to a supportive ho using setting. Supportive housing is temporary housing that allows a p atient to participate in an intensive hospital-based treatment program . Type and intensity of treatment were generally equivalent for the tw o groups. Methods: Patients were consecutive voluntary admissions to t he substance abuse treatment program of a large metropolitan Veterans Affairs medical center, Patients with serious medical conditions or hi ghly unstable psychiatric disorders were excluded. Patients in support ive housing attended the inpatient program on weekdays from 7:30 a.m. to 5 p.m. They were assessed at baseline and at two-month follow-up. R esults: Baseline analyses of clinical, personality, and demographic ch aracteristics revealed no substantive differences between the 62 patie nts assigned to inpatient treatment and the 36 assigned to supportive housing. The degree of treatment involvement and dropout rates did not differ between groups. Of the 55 inpatients completing treatment, 29 were known to be abstinent at follow-up, and of the 35 supportive hous ing patients completing treatment, 22 were abstinent, The proportion w as similar for both groups, about 70 percent. The cost of a successful treatment for the inpatient group was $9,524. For the supportive hous ing group, it was $4,291, Conclusions: Given the absence of differenti al treatment effects between inpatient and supportive housing settings , the use of supportive housing alternatives appears to provide an opp ortunity for substantial cost savings for VA patients with substance d ependence disorders.