ArticleSubstance use & addiction journal2025
Exploring Staff Beliefs About Unplanned Discharge and Related Harms in VA Substance Use Disorder Residential Programs: A Qualitative Study.
Article in Substance use & addiction journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundUnplanned 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.
methodsWe 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.
resultsWe 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.
conclusionsSUD 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.
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