En Bref- Traitement hospitalier ou traitement ambulatoire de la toxicomanie

contenu disponible en anglais seulement

Key Messages

• For individuals with alcohol use disorders, better detoxification completion and abstinence rates are reported in outpatient care compared with in-patient care (with the evidence based on a few studies with short follow-up periods of one to two months).
• Over a longer follow-up period, in-patients consumed less alcohol than outpatients in the year after entering treatment (according to data from one study).
• In patients with severe alcohol dependency, an initial benefit of in-patient over outpatient care in alcohol abstinence seems to decrease over time (according to data from one study).
• For patients with substance use disorders, in-patients are more likely to complete treatment than outpatients (according to data from one study).
• One guideline on opioid use disorder recommends that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an in-patient setting, for most patients.

Context

Substance use disorders can include abuse of prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. In 2012, members of an estimated 3.8% of Canadian households had a substance use disorder in the previous year, and 31.8% of regular Canadian Forces members had alcohol abuse or dependence in 2013.

Technology

Patients with substance use disorders can be treated with hospital- or residential-based programs (in-patient care), or with home- or community-based programs (outpatient care), with treatment options for both in-patient and outpatient care ranging from medication to counselling and recovery support services.

Issue

The clinical effectiveness of in-patient care programs compared to outpatient care programs for adults with substance use disorders is not clear, and in Canada, referral to in-patient versus outpatient facilities may vary across jurisdictions and clinical practices. A review of the evidence and guidelines associated with in-patient and outpatient treatment programs will help inform decisions regarding therapy.

Methods

A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results

A total of 977 citations were identified in the literature search, with one additional publication identified from the grey literature. Of these, five met the criteria for inclusion in this review — one systematic review, three primary clinical studies, and one guideline.