Inequity in the hospital care of patients with alcoholism and medication addiction.

In a psychiatric/ecological study, the authors investigated which aspects of a town district would provide an explanation to the fact that alcoholics are treated above average in addiction-psychiatric wards in a given city district, while in other districts treatment is carried out in internal medical wards. The research was based on data collected between 1988 and 1994 from approximately 77% of all patients suffering from alcohol and legal drug abuse (n = 15,473) in 41 hospitals in Hamburg. It was established that in somatic departments, mainly internal medicine, 70% of male and 67% of female patients were admitted for alcohol and legal drug abuse. The results of a geographical analysis of hospitalization risks showed that the addiction-psychiatric facilities of psychiatric wards are mainly utilized by inhabitants from nearby districts. Risks of above-average hospitalization for alcoholics and legal drug abusers in internal wards, as well as insufficient addiction-psychiatric care, are to be expected in town districts where a shortage of psychiatrists exists, and where the unemployment rate is high. In these crucial areas, addiction-specific facilities, such as qualified programs for detoxication or techniques for short intervention, should be established within the framework of an addiction-specific liaison service in general hospitals.