Relapse is a common part of the substance use disorder recovery process, especially in the early stages. Many individuals require more than one treatment admission to achieve sustained recovery from a substance use disorder. In some cases, relapse that leads to readmission after addiction treatment suggests the need for more comprehensive care. Gaining a greater understanding of what places patients at risk of readmission prepares providers to best help individuals recovering from substance use disorder.
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Overview of readmission rates and patterns
Research has unearthed some trends related to readmission rates, one of which involves the substance of choice. Studies show that individuals with cocaine, amphetamine, or opioid use disorders are more likely to experience rehospitalization after treatment compared to those abusing other drugs. [1][4]
Length of time spent in outpatient treatment also contributes to readmission in addiction treatment. One Swedish study found that men who participated in outpatient addiction treatment for longer periods of time experienced a lower rate of rehospitalization, but the same trend wasn’t observed in women. [2]Â
Interestingly enough, this same study discovered that the average number of outpatient visits someone received did not have a major effect on whether or not they were rehospitalized. [2] Since greater therapy intensity is traditionally recommended for individuals with more pressing health needs, this suggests the severity of someone’s addiction doesn’t necessarily lead to readmission.
Key predictors: Sociodemographic, clinical, & service use factors
Certain demographic populations are more at risk for readmission than others, according to research. For example, research has found that young males living in urban environments have the highest rate of treatment readmission after SUD treatment. Being unemployed and having more physical, social, or financial stressors also contributes to a higher risk for readmission. In addition, having multiple treatment stays and prior treatment drop-outs also makes someone more likely to be readmitted for subsequent treatment. [5]
The presence of co-occurring conditions also influenced the readmission rates of individuals in addiction treatment. A study conducted in Saudi Arabia found that individuals with mental health concerns were 7.25 times more likely to have a longer hospitalization compared to people without mental health conditions. [4] The more severe the person’s mental illness is, the higher the risk is for multiple admissions for SUD treatment. [5]
Insights from the Canadian longitudinal study
One of the most impactful pieces of research on readmission predictors in addiction treatment is a longitudinal study administered in Quebec. Across 5 years, investigators looked at over 8,000 patients diagnosed with one or more substance use disorders who sought care at specialized addiction treatment facilities. Results showed that 36% of patients were readmitted. This study also discovered the following groups displayed a higher rate of readmission: [5]
- Young adults
- Men
- Individuals with 5 or more prior admissions for substance use disorders
- Those who were unemployed
- Individuals living in urban or suburban regions
- People with chronic alcohol use disorder
- Those with co-occurring mental health conditions
- Anyone who waited up to 30 days to begin treatment
- Individuals who sought residential treatment for substance use disorders
- People who had high dropout rates during prior care episodes
- People who had established access to psychosocial services (such as therapy and psychiatry) with consistent continuity of care with their physician
- Those who frequently utilized acute care (specifically emergency care)
Each of these factors can complicate the care of an individual with substance use disorders, making it important to identify those at high risk of readmission.
Strategies to identify high-risk patients early
Some hospitals have attempted to better triage at-risk patients by offering team-based consultation and liaison services from mental health professionals and addiction treatment specialists. [4] However, these teams can only be effective if they are complemented by organizational evaluations to ensure their success.
Intervention models that reduce readmission
Aftercare is one of the most important interventions that can reduce readmission in substance use treatment. Aftercare includes residential, outpatient, and community-based treatment and support for people discharging from inpatient addiction treatment programs. Aftercare helps to promote long-term recovery from addiction by offering community support, resources, vocational training, and ongoing treatment. Studies show that participating in either medication-assisted treatment (MAT) or residential treatment after an initial hospitalization for SUD can help someone avoid future readmissions. [6]
Aftercare includes care transition programs, designed to help people in addiction recovery gradually step down treatment and support, rather than ending treatment suddenly. Care transition programs, patient/family education, and post-discharge follow-up have also proven effective in reducing hospitalizations. Existing literature has shown that care transition programs are most effective when providers meet with patients just prior to their discharge, between 2 and 3 days after discharge, and at least three times within the first month after discharge. In rehabilitation settings, this was shown to significantly lower readmission rates when measured at 30- and 90-day intervals. [7]Â
In some cases, high levels of readmission to or from a specific clinic can signal a problem with the quality of services being offered at the facility. Quality improvement initiatives should also be spearheaded in order to address facility-specific factors that contribute to rising readmission rates within a community. Outcomes tracking protocols can also be utilized to track the treatment readmission rates of specific facilities with both high and low readmission rates and explore causal factors.
The role of integrated care
Integrated care plays a large part in providing someone with comprehensive treatment that addresses substance use, medical, and mental health concerns. This often happens through an interdisciplinary team or when individual medical, mental health, and addiction treatment providers communicate with one another about a person’s treatment. Early research has confirmed the feasibility of these teams, particularly regarding their ability to educate surgical and medical teams about recommendations for shared patients. [1] This stands to improve SUD care and can improve outcomes for SUD patients receiving other medical care.
Final thought
Research has found several factors that at least partly predict readmission in addiction treatment. Understanding how to identify and remediate these factors improves outcomes for patients and boosts the chances for sustained recovery from addiction.
