Outcomes and costs of day hospital treatment and nonmedical day treatment for chemical dependency.

OBJECTIVE The purpose of this study was to estimate the outcomes and costs of day hospital and nonmedical community-based day treatment for chemical dependency. METHOD A community sample of 271 adults (179 men) dependent on alcohol and/or drugs was recruited and randomized to either a hospital-based (medical) day treatment program or to a community-based (nonmedical) day treatment program. The day hospital (DH) program lasted for 3 weeks. One community-based program (CP2) lasted for 4 weeks, and the other (CP1) lasted for 6 weeks but with shorter treatment days and more criminal justice clients. Because of our concerns regarding treatment fidelity, we replaced CP1 with CP2 as the randomization site for the nonmedical, community-based arm of the trial halfway through the study. RESULTS Abstinence rates were similar between DH and CP2 subjects, with 53% and 60% of each group, respectively, reporting no drinking for the 30 days preceding both follow-up interviews. DH subjects were less likely than those in either of the nonmedical programs to report medical problems at both follow-ups. Average episode costs per client were significantly (p < .01) lower at CP1 (dollars 526) than at DH (dollars 1,274) or CP2 (dollars 1,163). A pattern of weaker effects was observed at the less costly problematic community program (CP1), including less abstinence than was reported at CP2 (only 40% of CP1 subjects were alcohol free at both follow-ups) and worse psychiatric, family/friend and employment outcomes than were reported at DH or CP2. CONCLUSIONS Our results not only demonstrate the clinical diversity that exists between nonmedical, community-based day treatment programs but also show that nonmedical programs can compete with DH treatment in cost as well as in most outcomes.