An adult patient needs inpatient treatment if he or she meets the DSM diagnostic criteria for Substance Use Disorder and meets at least two of the following criteria:

A.  The patient presents a risk of severe withdrawal or the patient has had past failures at entering treatment after detoxification.
B.  Patient has medical conditions that present imminent danger of damaging health if use resumes or concurrent medical illness needs medical monitoring.

C. One of the following:
1.  Emotional/behavioral problems interfere with abstinence and stability to the degree that there is a need for a structured 24-hour environment.
2.  There is a moderate risk of behaviors endangering self or others. Current suicidal/homicidal thoughts with no action plan and a history of suicidal gestures or homicidal threats.
3.  The patient is manifesting stress behaviors related to losses or anticipated losses that significantly impair daily living. A 24-hour facility is necessary to address the addiction.
4.  There is a history or presence of violent or disruptive behavior during intoxication with imminent danger to self or others.
5.  Concomitant personality disorders are of such severity that the accompanying dysfunctional behaviors require continuous boundary-setting interventions.

D.  Despite consequences, the patient does not accept the severity of the problem and needs intensive motivating strategies available in a 24- hour structured setting.

E.  One of the following:
1.  Despite active participation at a less intensive level of care or in a self-help fellowship,  that patient is experiencing an acute crisis with an intensification of addiction symptoms.  Without 24-hour supervision, the patient will continue to use.
2.  The patient cannot control her or his use as long as alcohol or drugs are present in the environment; or
3.  The treatments necessary for this patient require this level of care.

F.  One of the following:
1.  The patient lives in an environment in which treatment is unlikely to succeed (e.g., chaotic environment, rife with interpersonal conflict, which undermines the patient’s efforts to change, nonexistent family,  or their environmental conditions,  or significant others living with the patient manifest current substance use and are likely to undermine the patient’s recovery).
2.  Treatment accessibility prevents participation in a less intensive level of care.
3.  There is a danger of physical, sexual, or emotional abuse in the current environment.
4.  The patient is engaged in an occupation where continued use constitutes a substantial imminent risk to personal or public safety.

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Robert R. Perkinson,  PHD
Helping Your Clients Find the Road to Recovery

Alcoholism - Treatment.  I.  Title.
RC565.P375 - 2004
616.86’10651- dc22