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Systematic Review
1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?
2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?
For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. The evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper.
For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates,were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation.In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings.