Home Treatment for Individuals Suffering From Severe Addictive Disorders

Study Overview
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Brief Summary
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Home Treatment (HT) has been successfully implemented in adult psychiatry in several countries including Switzerland. Patients with addiction problems were generally excluded even if the latter was not the main diagnosis. On the other hand, community treatments have successfully been established for these individuals. The investigators have recently offered HT to persons with severe addictive disorders which was well accepted. The investigators intend to conduct a pilot study to prepare a large-scale study if successful. The investigators intend to compare HT to treatment as usual (regular inpatient treatment) on a specialized ward with respect to readmission rates during 6 months after discharge. The data show that 70.8% of all readmissions occur during the first 6 months. Therefore, a period of 6 months is considered an adequate time interval to sufficiently answer this pilot study's question.

Official Title
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A Pilot Study on Home Treatment for Individuals Suffering From Severe Addictive Disorders

Conditions
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Substance Use Disorders

Intervention / Treatment
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* Other: Hospital-like treatment in patients' home
* Other: standard inpatient treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Substance use disorder age 18 or above sufficient french language skills competent subjects consent to randomization progress Exclusion Criteria: organic brain disease or developmental disorder non voluntary admission severe somatic comorbidity History of complicated substance withdrawal acute suicidal ideation aggressive behavior acute psychiatric disease such as mania or psychosis distance to center (must be reachable within 60 minutes)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Pilot study, randomized, open, non-blinded
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Home treatment<br>Home visits by care staff at the same frequency as in hospital | Other: Hospital-like treatment in patients' home<br>* Hospital-like treatment in patients' home. Caregivers, medical doctors and social workers will make several visits per day to the patients' home. 24/7 contact is available.<br>|
| Active Comparator: Standard inpatient treatment<br>Inpatient treatment on hospital ward | Other: standard inpatient treatment<br>* Inpatient treatment on addiction ward<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| readmission rates | Number of readmissions to hospital during the 6 months following discharge | 6 month post-discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| time to readmission | Number of days between discharge and readmission during the 6 months following discharge | 6 months | 
| length of hospitalization | total number of days spent in hospital during the 6 months following discharge | 6 months | 
| number of emergency room visits | number of emergency room visits during the 6 months following discharge | 6 months | 
| clinical outcome | clinical outcomes measured with Health of the Nation Outcome scale (HoNOS) scoring 0 (no symptoms) to 48 (high symptom level) and the Brief Symptom Check-List (short form of the Brief Symptom Inventory), scoring 0-53 items (higher score = more symptoms). Measured at the start and end of intervention/hospital treatment. | 6 months | 
| patient satisfaction | Patient satisfaction measured with the S-ANQ (https://www.anq.ch/en/), a questionnaire used by all Swiss hospitals to measure patient satisfaction with treatment. The questionnaire includes 6 questions which are marked from 0 not at all satisfied to 5 = very satisfied. Scoring 0 (not at all satisfied) to 30 (very satisfied) | 6 months |