Attrition within a detoxification unit: patient response to policy and psychological intervention

Professional psychological consultation with selected substance abusers was found in earlier work to stabilize patients as well as create organizational change. All patients subsequently were to undergo a psychological consultation. Three consecutive 10-month samples of male veterans (N = 254, 309, and 261) undergoing inpatient detoxification showed characteristic rectilinear decay curves while those refusing psychological consultation showed poisson-like negatively accelerating decay curves. Distributions clearly reflect (a) treatment contract, either 14- or 21-day length of stay; (b) presence or absence of a psychological consultation; and (c) an unknown factor. It is hypothesized that in addition to policy, the psychological focus upon self-experience rather than behavior had become internalized by the treatment team, thus creating a calmer interpersonal atmosphere, one more able to sustain the irritability, demandingness, and negativism of substance abusers, though with emotional cost to those involved. It is suggested that enlightened mental health policy be introduced on a wider scale.