This study investigates the burden of medical comorbidity in a population of patients receiving inpatient drug and alcohol treatment.
We conducted the study as a cross-sectional survey. We did not seek to demonstrate the efficacy of interventions, but rather to explore the population’s characteristics.
The study was undertaken in a specialist inpatient assessment and detoxification unit (The Ritson Clinic) in a large psychiatric hospital (The Royal Edinburgh Hospital). Referrals to the unit come from community substance misuse teams operating within the local NHS health board, a catchment population of over 800,000 covering Edinburgh and the Lothians, the second largest residential population in Scotland.
Participants included all admissions over a six-month period (26 May, 2014 to 27 November, 2014). The clinic provides assessment, medical detoxification and stabilisation for patients dependent on alcohol, opioids and, less commonly, other substances including benzodiazepines, stimulants and Novel Psychoactive Substances (NPS). Patients who are admitted are unsuitable for community-based treatment due to a combination of medical, psychiatric or social complexities.
In addition to demographic data, reason for admission, psychiatric diagnoses, medication count and presence or absence of chronic pain, we recorded a range of medical diagnoses that allowed the calculation of predicted ten-year survival using the Charlson Comorbidity Index.
Findings and Conclusions
Despite the majority of the sample having a predicted ten-year survival of greater than 75%, a sizeable minority (16.7%) are carrying a high burden of medical comorbidity, with a predicted ten-year survival of less than 50%. More than half (55.2%) of these patients were under the age of 55. Chronic respiratory disease was the most frequent diagnosis.
Our data would suggest that inpatient substance misuse units serve a complicated group of patients. In addition to interventions for their dependence, these patients’ needs are met by active medical input, resident medical cover and effective liaison with general hospitals. This is important when planning and commissioning treatment services. The high burden of respiratory disease suggests the utility of robust smoking cessation interventions amongst this population.
Dr Rebecca J. Lawrence (Consultant Psychiatrist, NHS Lothian, Edinburgh, UK)
Conflicts of interest: