Impact of psychiatric follow-up in a specialized outpatient clinic for psychoactive substances on the length of stay of users in a therapeutic community

Abstract

INTRODUCTION: Substance use disorders (SUD) represent a major public health problem, associated with high morbidity and mortality as well as psychosocial impairment. Treatment retention is recognized as an essential variable for better outcomes, including social reintegration and relapse reduction. However, voluntary inpatient programs show high rates of early dropout, especially among individuals with untreated psychiatric comorbidities. In Brazil, following the New Drug Law (2019), Therapeutic Communities (TCs) have become established as an important resource for therapeutic care. The integration of psychiatric follow-up into TCs may improve adherence, although empirical evidence on its impact remains limited. The Psychoactive Substances Teaching Outpatient Clinic of the ABC Medical School (ADSPA-FMABC) provides specialized follow-up for residents of the Desafio Jovem Therapeutic Community in Santo André, constituting an integrated care model suitable for objective evaluation. Thus, by comparing the length of stay in the TC of patients followed by ADSPA-FMABC with those not followed, this study aimed to measure the impact of specialized psychiatric services on patient adherence to SUD treatment. METHOD: This is a retrospective observational study analyzing 621 records (Nov/2021 to Jun/2025), including patient admission and discharge dates from the TC. The sample comprised 123 patients followed by ADSPA-FMABC and 498 not followed. RESULTS: After confirming homogeneity of variances, a Student’s t-test was applied to compare the mean length of stay in the TC between the groups. Patients followed by ADSPA-FMABC had a mean stay of 126 days, whereas the nonfollowed group had a mean of 91 days. This mean difference of 35 days was statistically significant (t = 4.59; p < 0.001). DISCUSSION: Psychiatric followup in a specialized outpatient clinic proved to be a statistically significant factor in increasing voluntary length of stay in TCs and, consequently, in improving treatment adherence. CONCLUSION: This study demonstrated that integration between residential care and specialized medical support may represent a relevant strategy to enhance the treatment of patients with SUD.