Psychiatric consultations for psychoactive substance disorders in the general hospital

A series of 511 consultations to a psychiatric consultation-liaison service was studied. Patients diagnosed with substance abuse disorders were found more likely to be younger, male, and nonwhite. Payer status was not significantly different. Psychiatric consultants' recommendations for substance abuse patients more often consisted of aftercare referral, with less utilization of nonmedical consultations, environmental manipulations, social support, and psychological testing. Further, nonsubstance abusers received more and longer follow-up visits. Overall length of stay was shorter for substance-abuse cases, and for nonabusing cases earlier consultation was associated with briefer hospital stay. The authors discuss factors that may explain these findings, and urge psychiatric consultants to rethink their approach to these patients. A thorough, thoughtful diagnostic evaluation and consideration of a variety of interventions is always indicated.