Acute Care for a Chronic Brain Disorder: A Three-Year Descriptive Study of Substance-Related Admissions in a Romanian Psychiatric Hospital

Abstract

Substance dependence is a chronic relapsing brain disorder, yet inpatient services frequently deliver only acute stabilisation. The weeks following detoxification represent the period of most rapid cortical recovery in early abstinence and, simultaneously, of high relapse risk. Whether this window is protected depends largely on how inpatient services are organised. Objective: To characterise three years of substance-related inpatient activity at a Romanian tertiary psychiatric hospital and to assess whether the pattern of care is consistent with the management of a chronic disorder. Methods: Retrospective, observational, descriptive study of routinely collected discharge data from 1 January 2023 to 31 December 2025. Records were pseudonymised and linked across the full 36-month window. Two nested cohorts were analysed: admissions with an ICD-10 F10–F19 code as principal diagnosis (Cohort A) and admissions with such a code in any diagnostic position (Cohort B). Analysis was descriptive; no inferential testing was performed. Readmission was defined as any subsequent inpatient admission within the observation window, irrespective of the diagnosis recorded, and therefore indexes return to hospital rather than relapse. Results: Cohort B comprised 10,400 admissions among 6,038 patients; Cohort A comprised 1,681 admissions among 1,455 patients, a ratio of 5.2 secondary-diagnosis admissions to each principal-diagnosis admission. Cohort A patients were predominantly male (88.9%; mean age 45.1 years). Acute intoxication and harmful use accounted for 61.4% of principal-diagnosis admissions, with a median length of stay of 3.9 days in Cohort A. Discharge at the patient's own request occurred in 38.5% of admissions, rising from 36.0% to 40.9% across the period and reaching 54.2% for harmful use. The highest-utilising 20% of patients generated 49.4% of admissions. Median time to readmission was 67.6 days; 33.0% of readmissions occurred within 30 days and 14.6% within seven. One-year readmission was 40.4%. Total reimbursement was 4,817,022 RON across 10,116 bed-days (approximately EUR 965,000). Conclusions: Care was delivered almost entirely within the acute phase. Engagement frequently ended once the physical crisis had resolved, and readmissions clustered in the weeks immediately following discharge; the interpretation of this clustering in neurobiological terms is a hypothesis suggested by these data rather than a finding tested by them. Case identification based on principal diagnosis captures approximately one sixth of relevant activity. These findings provide a descriptive baseline that supports prospective evaluation of post-detoxification rehabilitation capacity.