Diagnosis: Alcohol dependence and substance abuse Treatment: Rehab for alcohol dependence The insurer has denied inpatient admission. That denial was reversed. This male patient was admitted to inpatient substance rehabilitation treatment as he reportedly was drinking 1 gallon of whiskey 1-2 times per week, smoking a blunt of cannabis daily, using 30 mg of Percocet 1-2 times per week, and could not maintain abstinence. It was reported that the patient was discharged after threatening violence towards a staff member. It also was reported that he was picking and scratching his head. He refused aftercare referrals. The American Psychiatric Association (APA) Practice Guidelines for the Treatment of Patients with Substance Use Disorders reports that inpatient treatment is indicated primarily for individuals whose lives and social interactions have come to focus exclusively on substance use and who currently lack sufficient motivation and/or substance-free social supports to remain abstinent in an ambulatory setting. In this case, this patient was considered in need of 24 hour substance rehabilitation treatment as he was using multiple substances; including alcohol, opiates, and cannabis. According to the LOCADTR, he met criteria for inpatient substance rehabilitation treatment as he continued to use multiple substances despite past inpatient treatments. It was reported that he was increasing frequency and amount of use. He was unable to stop substance and alcohol use without being in a sober and supervised therapeutic inpatient residential setting. Without this structured and supervised therapeutic residential treatment he likely would have relapsed quickly. Based on the above, the medical necessity for the inpatient hospital stay is substantiated.

1) The American Psychiatric Association Practice Guidelines for the Treatment of Patients with Substance Use Disorders