Riblet Natalie B, Stevens Susan, Kenneally Lauren, Zubkoff Lisa, Gottlieb Daniel J, Shiner Brian, Ley-Thomson Melissa, Rusch Brett
Veterans Affairs Medical Center, White River Junction, VT, USA.
Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Subst Use Addctn J. 2025 Oct;46(4):926-938. doi: 10.1177/29767342251335731. Epub 2025 May 12.
Unplanned discharge is common in substance use disorder (SUD) residential programs and associated with worse outcomes such as relapse and suicide. There is high variation in unplanned discharge rates across Department of Veterans Affairs (VA) SUD residential programs. Little is known about program factors related to unplanned discharge in these settings. We aimed to discover staff beliefs about avoiding unplanned discharge and related harms in VA SUD residential programs.
We identified VA sites with low (<10%) and high rates (≥30%) of unplanned discharge. Informed by the Theory of Planned Behavior, we conducted semi-structured interviews with staff members at sites to learn about staff beliefs about unplanned discharge and its related harms in SUD residential settings. Two analysts reviewed the data and employed a combination of directed-content analysis and inductive methods to identify themes stratified by high- versus low-rate sites.
We enrolled 10 sites (20 participants). There was high variability in how participants and sites operationalized unplanned discharge. Participants at low-rate sites generally emphasized harm-reduction approaches as useful ways to treat problematic behaviors that could result in an unplanned discharge. Participants at high-rate sites, on the other hand, favored the use of boards or councils to manage these concerns.
SUD residential programs should standardize the way that they define and document unplanned discharge. Future research should study the role of harm-reduction strategies and councils in mitigating unplanned discharge and related harms.
在物质使用障碍（SUD）住院项目中，意外出院情况很常见，且与诸如复发和自杀等更糟糕的结果相关。退伍军人事务部（VA）的SUD住院项目的意外出院率差异很大。对于这些环境中与意外出院相关的项目因素知之甚少。我们旨在了解VA的SUD住院项目中工作人员对于避免意外出院及相关危害的看法。
我们确定了意外出院率低（<10%）和高（≥30%）的VA机构。基于计划行为理论，我们对这些机构的工作人员进行了半结构化访谈，以了解他们对SUD住院环境中意外出院及其相关危害的看法。两名分析师对数据进行了审查，并采用定向内容分析和归纳方法相结合的方式，确定按高低率机构分层的主题。
我们纳入了10个机构（20名参与者）。参与者和机构对意外出院的操作方式差异很大。低率机构的参与者通常强调减少伤害的方法是处理可能导致意外出院的问题行为的有用方式。另一方面，高率机构的参与者则倾向于使用委员会来管理这些问题。
SUD住院项目应规范其定义和记录意外出院的方式。未来的研究应探讨减少伤害策略和委员会在减轻意外出院及相关危害方面的作用。
