Ionela-Violeta Ragea, Simona-Dana Mitincu-Caramfil, Rusu-Negraia Magdalena, Cătălin Pleșea-Condratovici, Valeriu Ardeleanu, Ramona-Oana Roșca, Laurențiu Drăguș, Lavinia-Alexandra Moroianu
Substance use disorders (SUDs) represent a major psychiatric and public health burden. Although integrated biopsychosocial approaches combining pharmacotherapy with psychosocial and behavioral interventions are recommended by international guidelines, real-world evidence on their effectiveness in acute emergency settings remains scarce, particularly in Eastern European healthcare contexts. This single-center, retrospective, observational study examined behavioral and psychosocial predictors of clinical response and compared an integrated therapeutic strategy (pharmacotherapy combined with psychosocial and behavioral interventions) with pharmacotherapy alone among all emergency psychiatric admissions for SUDs (ICD-10 F10-F19) at the Clinical Psychiatric Hospital "Elisabeta Doamna," Galați, Romania, between January 2020 and December 2024 (N = 331; census sampling). The primary outcome was clinical status at discharge (improved/stationary/worsened). Patients receiving the integrated strategy showed a significantly higher improvement rate at discharge than those receiving pharmacotherapy alone (98.3% vs. 76.3%; OR = 17.88; 95% CI: 5.62-56.91; p < 0.001). A hospitalization window of 4-14 days was associated with optimal outcomes. In an exploratory logistic regression analysis, older age (≥51 years) and unemployment emerged as independent psychosocial predictors of suboptimal response. These findings suggest that integrating behavioral and psychosocial interventions with pharmacotherapy is associated with superior discharge outcomes in acute SUD management; given the observational, non-randomized design, these results should be regarded as hypothesis-generating rather than causal, pending confirmation in prospective multicenter studies before informing behaviorally informed triage and risk stratification in emergency psychiatry.