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Original article

Vol. 152 No. 3132 (2022)

Referral to aftercare following inpatient withdrawal treatment and readmission: retrospective chart review of patients with substance use disorders

  • Benedikt Habermeyer
  • Barbara Lay
  • Norbert Scherbaum
  • Udo Bonnet
  • Patrik Roser
Cite this as:
Swiss Med Wkly. 2022;152:w30213


AIMS OF THE STUDY: Aftercare following inpatient withdrawal treatment improves the prognosis and prevents future readmissions in patients with substance use disorders. According to the stepped care approach, the setting and intensity of aftercare should be adjusted to the patients’ specific needs and resources. This study evaluated the real-life referral to different types of aftercare in Switzerland and the rate of inpatient readmission within a 1-year follow-up.

METHODS: All substance use disorder patients admitted for inpatient withdrawal treatment in a Swiss psychiatric hospital between January and December 2016 (n = 497) were included in this retrospective study. Clinical and sociodemographic characteristics were extracted from the electronic medical records and their impact on the likelihood of being referred to a particular type of aftercare (general practitioner, psychiatric outpatient care, psychiatric day clinic, inpatient rehabilitation programme) was evaluated. For each type of referral, we determined the readmission rate within one year after discharge.

RESULTS: In the sample of substance use disorder patients (mean age 41 years; 69% male), alcohol use disorder was by far the most frequent substance use disorder. Most patients were referred to psychiatric outpatient care (39.8%), followed by a general practitioner (31.0%), inpatient rehabilitation (19.3%) and psychiatric day clinic (9.9%). Patient characteristics that point to an unfavourable course of disease, including higher symptom severity, history of more than two previous admissions, compulsory admission and treatment discontinuation, were associated with a higher likelihood to be referred to lower-level aftercare (general practitioner, psychiatric outpatient care), whereas patients with lower symptom severity, fewer than two previous admissions, voluntary admission and regular discharge were more likely to be referred to high-intensity aftercare (psychiatric day clinic, inpatient rehabilitation). The readmission rate after one year did not differ between the different settings of aftercare (range 40.4–42.9%).

CONCLUSIONS: The findings of this study suggest that patients suffering from severe substance use disorders and/or from an unfavourable course of disease who would benefit from a more intensive aftercare setting, such as psychiatric day clinics or inpatient rehabilitation programs, might be under-treated, whereas patients with a rather favourable prognosis might similarly benefit from a less intensive treatment setting, such as psychiatric outpatient care. Regarding the comparable readmission rates, we recommend  considering more efficient resource management by promoting stepped care approaches for substance use disorders and establishing standardised placement criteria in Switzerland.


  1. Dennis M, Scott CK. Managing addiction as a chronic condition. Addict Sci Clin Pract. 2007 Dec;4(1):45–55.
  2. McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. J Nerv Ment Dis. 1980 Jan;168(1):26–33.
  3. Proctor SL, Herschman PL. The continuing care model of substance use treatment: what works, and when is “enough,” “enough?”. Psychiatry J. 2014;2014:692423.
  4. Reif S, Acevedo A, Garnick DW, Fullerton CA. Reducing behavioral inpatient readmissions for people with substance use disorders: do follow-up services matter? Psychiatr Serv. 2017 Aug;68(8):810–8.
  5. Deutsche Gesellschaft für Psychiatrie und Psychotherapie. Psychosomatik und Nervenheilkunde. S3-Leitlinie Screening, Diagnose und Behandlung alkoholbezogener Störungen; 2020 [Internet]. Available from:
  6. McCarty D, Braude L, Lyman DR, Dougherty RH, Daniels AS, Ghose SS, et al. Substance abuse intensive outpatient programs: assessing the evidence. Psychiatr Serv. 2014 Jun;65(6):718–26.
  7. Lotz-Rambaldi W, Buhk H, Busche W, Fischer J, Bloemeke U, Koch U. [Outpatient rehabilitation of alcohol dependent patients in a day clinic: initial results of a comparative follow-up study of day clinic and inpatient treatment]. Rehabilitation (Stuttg). 2002 Apr-Jun;41(2-3):192–200.
  8. Reif S, George P, Braude L, Dougherty RH, Daniels AS, Ghose SS, et al. Residential treatment for individuals with substance use disorders: assessing the evidence. Psychiatr Serv. 2014 Mar;65(3):301–12.
  9. TARPSY. tarifsuisse [Internet]. c2020. Available from:
  10. Heekeren K, Antoniadis S, Habermeyer B, Obermann C, Kirschner M, Seifritz E, et al. Psychiatric acute day hospital as an alternative to inpatient treatment. Front Psychiatry. 2020 May;11:471.
  11. American Society of Addiction Medicine. ASAM PPC-2R Patient Placement Criteria for the Treatment of Substance-Related Disorders. 2nd ed. Chevy Chase (MD): American Society of Addiction Medicine; 2007.
  12. Stallvik M, Gastfriend DR, Nordahl HM. Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software. J Subst Use. 2015;20(6):389–98.
  13. Schippers GM, Broekman TG, Buchholz A, Rutten R. Introducing a new assessment instrument: The Measurements in the Addictions for Triage and Evalution (MATE). Sucht. 2009 Aug;55(4):209–18.
  14. Schippers GM, Broekman TG, Buchholz A, Koeter MW, van den Brink W. Measurements in the Addictions for Triage and Evaluation (MATE): an instrument based on the World Health Organization family of international classifications. Addiction. 2010 May;105(5):862–71.
  15. Buchholz A, Dams J, Rosahl A, Hempleman J, König HH, Konnopka A, et al. Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: primary outcomes of an exploratory randomized controlled trial. Eur Addict Res. 2020;26(3):109–21.
  16. Röhrig J, Buchholz A, Wahl S, Berner M. Placement matching for patients with alcohol use disorders using standardized assessment: A pilot study. J Subst Use. 2015;20(2):97–105.
  17. Praxis Suchtmedizin. Entwöhnung/Langzeittherapie [Internet]. c2020. Available from:
  18. Deutsche Rentenversicherung Bund. Vereinbarungen im Suchtbereich [Internet]. c2013. Available from:
  19. Haug S. Wirksamkeit ambulanter Beratung bei Alkoholproblemen. Zürich: Schweizerisches Institut für Sucht- und Gesundheitsforschung; 2015.
  20. John U. Prävalenz und Sekundärprävention von Alkoholmissbrauch und -abhängigkeit in der medizinischen Versorgung. Nomos; 1996.
  21. Rüesch P, Bänziger A, Juvalta S. Regionale psychiatrische Inanspruchnahme und Versorgungsbedarf in der Schweiz. Datengrundlagen, statistische Modelle, ausgewählte Ergebnisse – eine explorative Studie. Neuchâtel: Schweizerisches Gesundheitsobservatorium; 2013.
  22. Hill A, Rumpf HJ, Hapke U, Driessen M, John U. Prevalence of alcohol dependence and abuse in general practice. Alcohol Clin Exp Res. 1998 Jun;22(4):935–40.
  23. Köhler J, Grünbeck P, Soyka M. [Applicability, duration, and sociomedical course of rehabilitation of alcohol dependency. Current results and perspectives from the insurers’ point of view]. Nervenarzt. 2007 May;78(5):536–46.
  24. Vincent C, Staines A. Enhancing the Quality and Safety of Swiss Healthcare. Bern: Federal Office of Public Health; 2019.
  25. Andreas S, Harries-Hedder K, Schwenk W, Hausberg M, Koch U, Schulz H. Is the Health of the Nation Outcome Scales appropriate for the assessment of symptom severity in patients with substance-related disorders? J Subst Abuse Treat. 2010 Jul;39(1):32–40.
  26. OECD. Psychiatrists and mental health nurses [Internet]. OECD Publishing. Available from:
  27. Deutsche Rentenversicherung Bund. Reha-Bericht: Update 2014 [Internet]. Available from:
  28. Deutsche Hauptstelle für Suchtfragen. DHS Jahrbuch Sucht 2020 [Internet]. Available from:
  29. Delargy I, Crowley D, Van Hout MC. Twenty years of the methadone treatment protocol in Ireland: reflections on the role of general practice. Harm Reduct J. 2019 Jan;16(1):5.
  30. Scherbaum N, Holzbach R, Stammen G, Kirchof U, Bonnet U. Very low frequency of drug therapy of alcohol dependence in Germany - Analysis of data of a statutory health insurance. Pharmacopsychiatry. 2020 Jan;53(1):37–9.
  31. de Andrade D, Elphinston RA, Quinn C, Allan J, Hides L. The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug Alcohol Depend. 2019 Aug;201:227–35.
  32. Hesselius P. Does sickness absence increase the risk of unemployment? J Socio-Economics. 2007;36(2):288–310.
  33. Böckmann V, Lay B, Seifritz E, Kawohl W, Roser P, Habermeyer B. Patient-level predictors of psychiatric readmission in substance use disorders. Front Psychiatry. 2019 Nov;10:828.
  34. Hasin D, Liu X, Nunes E, McCloud S, Samet S, Endicott J. Effects of major depression on remission and relapse of substance dependence. Arch Gen Psychiatry. 2002 Apr;59(4):375–80.
  35. Worley MJ, Trim RS, Tate SR, Hall JE, Brown SA. Service utilization during and after outpatient treatment for comorbid substance use disorder and depression. J Subst Abuse Treat. 2010 Sep;39(2):124–31.
  36. Hunt GE, Large MM, Cleary M, Lai HM, Saunders JB. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: systematic review and meta-analysis. Drug Alcohol Depend. 2018 Oct;191:234–58.
  37. Lambert M, Conus P, Lubman DI, Wade D, Yuen H, Moritz S, et al. The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatr Scand. 2005 Aug;112(2):141–8.
  38. Weibell MA, Hegelstad WT, Auestad B, Bramness J, Evensen J, Haahr U, et al. The effect of substance use on 10-year outcome in first-episode psychosis. Schizophr Bull. 2017 Jul;43(4):843–51.
  39. Habermeyer B, Wyder L, Roser P, Vogel M. Coercion in substance use disorders: clinical course of compulsory admissions in a Swiss psychiatric hospital. Swiss Med Wkly. 2018 Sep;148:w14644.
  40. Mark TL, Vandivort-Warren R, Montejano LB. Factors affecting detoxification readmission: analysis of public sector data from three states. J Subst Abuse Treat. 2006 Dec;31(4):439–45.
  41. Verhaeghe M, Bracke P, Christiaens W. Part-time hospitalisation and stigma experiences: a study in contemporary psychiatric hospitals. BMC Health Serv Res. 2008 Jun;8(1):125.
  42. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr;360(14):1418–28.
  43. Slater EJ, Linn MW. Predictors of rehospitalization in a male alcoholic population. Am J Drug Alcohol Abuse. 1982-1983-1983;9(2):211–20.
  44. Van den Berg JF, Van den Brink W, Kist N, Hermes JS, Kok RM. Social factors and readmission after inpatient detoxification in older alcohol-dependent patients. Am J Addict. 2015 Oct;24(7):661–6.