Unscheduled admissions and AMA discharges from a substance abuse unit

On the inpatient substance abuse service of the Philadelphia Veterans Administration Hospital, we found that patients who were admitted to the hospital ''unscheduled'' had a disproportionately higher incidence of subsequent AMA (against medical advice) discharge, particularly if they were alcoholic. This finding calls into question the cost-effectiveness of hospitalization as an initial treatment strategy for substance abusers who enter treatment impulsively and points out the need for additional study to determine the most cost-effective treatments for addicts whose primary motivation for treatment may be to obtain relief from precipitating stressors.