Factors Associated with Unplanned Early Discharges from a Dual Diagnosis Inpatient Detoxification Unit in Israel

Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this study as well as explore possible associations between clinical/demographic factors and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates.

In this retrospective study, medical records of all patients admitted to the unit between January 1, 2012, and July 1, 2013, were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson's chi-squared test and binary logistic regression.

Patients admitted to our unit were affected by schizophrenia (31.8%), personality disorder (25%), and depression (18.3%). Substances in use included alcohol (67.5%), cannabis (8.35%), and benzodiazepines (9%). Almost half of the patients were polysubstance users (48.9%). The unit had high rates of immigrants, mainly ex-USSR- and Ethiopian-born. It had low rates of individuals who had served in the army (52.8%), despite the service being mandatory in Israel. Sixty-eight percent of patients completed the program as planned, and 32% were discharged early: 8.6% discharged due to drug use in detoxification settings, violence, or hospitalization for clinical reasons and 23.2% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7% of patients with severe mental illness, 44.3% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found that patients with disability pensions (odds ratio [OR] = 0.36; 95% confidence interval [CI] [0.14-0.91]; p = .03) and polysubstance use (OR = 0.39; 95% [CI] [0.23, 0.66], p < .001) had a higher risk of early discharge. Upon completion of individual programs, 52% were referred to an ambulatory addiction center and 13% to a nationally sponsored dual diagnosis therapeutic community.

Israel's single official dual diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. A suboptimal treatment regimen may contribute to the early discharge of patients with polysubstance use and diagnosed personality disorders. An association between early discharges and a disability pension warrant further investigation, as there is no apparent connection between the two.