Crack/Cocaine Abusers in the General Hospital: Assessment and Initiation of Care

Objective: Cocaine, either smoked (as “crack “) or taken intranasally, is now a common cause of psychiatric illness. This study was designed to assess the impact of cocaine abuse on a general psychiatric service and an obstetrics service in an urban general hospital and to evaluate a program for engaging affected patients in addiction treatment. Method: The charts of 300 general psychiatric patients (not admitted for addiction treatment) and 60 cocaineabusing prenatal or postpartum patients were reviewed. A treatment referral program based on professionally directed peer leadership was established for patients with cocaine abuse. Results of evaluation and referral of 1 00 other cocaine-abusing psychiatric patients and the 60 prenatal or postpartum patients were then determined. Results: Fully 64% (N=1 91) of the 300 psychiatric patients were diagnosed as substance abusers; 38% (N=1 13) of them abused cocaine. Almost one-third ofthese cocaine abusers had no axis I diagnosis other than substance abuse/dependence, and the majority were homeless. Urine samples were positive for cocaine in a majority ofthe obstetric patients studied. A majority ofthe psychiatric patients who were referred through the peer-led program enrolled in outpatient cocaine treatment-three times as many as in the chart review group. Most ofthe obstetric patients suitable for referral enrolled f or treatment as well. Conclusions: Cocaine abuse may be responsible for a large portion of psychiatric admissions in urban public general hospitals. Cocaine abusers in psychiatric and obstetrics services are apparently responsive to a peer-oriented mode ofreferral into treatment. (Am J Psychiatry 1 992; 149:810-815)