Exploring the Relationship between Access and Retention among Substance Abuse Treatment Admissions

Article excerpt

To explore whether relationships exist among the timeliness of access to outpatient (OP) and intensive outpatient (IOP) substance abuse assessment and treatment and the participation, retention and completion of treatment, admission data from the State of Maine substance abuse treatment data system, reflecting episodes both admitted and discharged during state fiscal year 2008 (N=6,157) were examined using linear and logistic regression techniques. Shorter wait times for assessment were found to lead to lower rates of treatment completion for both OP and IOP and to fewer numbers of sessions attended and shorter lengths of stay for IOP. Shorter waits between assessment and treatment were found to lead to lower attendance at OP treatment sessions, shorter lengths of stay for OP and IOP, but higher rates of treatment completion for IOP. Policy implications are discussed.

INTRODUCTION

Within the substance abuse treatment field, a recurring policy and clinical question arises: Does the provision of quicker access to services negatively impact aggregate session attendance, retention, and completion of treatment outcomes? Implicit in this question is the idea that making access easier allows a broader spectrum of clients, including those who may have more severe substance use disorders, to access treatment. Allowing clients with more complex needs into treatment may require additional or different organizational resources and may challenge the attainment of programmatic outcome benchmarks. Most state systems, however, do not currently capture sufficient information to be able to examine this issue from a clinical standpoint. Administrative data can be used to explore this claim from another angle. As state substance abuse agencies struggle to support existing treatment infrastructures while facing restrictions in funding and resources, it is important to understand how an emphasis on rapid access to services might impact the overall system. Recent enhancements to the state treatment data system in Maine have allowed for the detailed collection of both access and retention data. The purpose of this article is to utilize this administrative data to examine whether the timeliness of access to assessment and treatment within outpatient services is related to session attendance, length of stay, and completion of outpatient (OP) and intensive outpatient (IOP) treatment.

LITERATURE REVIEW

The impact of substance use and abuse on individual health, education, labor force participation, workplace attendance and job performance has been well-documented (Bombadier et al., 2004; Harwood, Fountain, & Livermore, 1998; Kandel & Davies, 1990; Kandel & Yamaguchi, 1987; National Institute of Drug Abuse [NIDA], 2007; National Institute of Drug Abuse, 2003; Wallace & Bachman, 1991; Wilson, 1996; Zhang & Snizek, 2003). At a broader level, substance abuse also exacts economic costs on society (Harwood, Fountain, & Livermore, 1998). In Maine, a racially homogeneous state with approximately 1 .3 million residents, a 2007 report estimated the 2005 cost of substance abuse at $898 million, with the largest proportion of the cost attributed to related crime (Maine Office of Substance Abuse, 2007). To address issues of substance abuse among its population, the State of Maine substance abuse agency supports a continuum of substance abuse related services, including prevention, intervention and treatment. The substance abuse treatment system includes a network of public, non-profit, and private service providers that provide detoxification services, residential services, outpatient services, intensive outpatient services, case management, or medication assisted treatment.

Empirical evidence has shown that substance abuse treatment is a cost effective method for addressing substance abuse (Scanlon, 2002) and that treatment is effective in limiting substance use, criminal activity, and improving quality of life outcomes for as many as five years after treatment (Atanda, Atkinson, & Mulvey, 2005; Jordan et al. …