Program characteristics and readmission among older substance abuse patients: comparisons with middle-aged and younger patients.

Older substance abuse patients were compared to middle-aged and younger patients before, during, and after an index episode of inpatient care in 1 of 88 substance abuse treatment programs. Associations between program characteristics and readmission rates adjusted for key differences in the types of patients in different programs varied by age group. Among older patients, more structured program policies, more flexible rules about discharge, more comprehensive assessment, and more outpatient mental health aftercare were associated with lower casemix-adjusted readmission rates. More intensive treatment was associated with higher-than-predicted readmission. By contrast, among younger patients, more family involvement in assessment and treatment, community consultation, and treatment emphasizing the development of social and work skills were associated with lower casemix-adjusted readmission rates. The findings suggest that intensive, directed treatment may be more effective for younger substance abuse patients, whereas a more supportive treatment regimen in a well-organized program and prompt outpatient aftercare may be especially helpful for older patients.