Intensive substance abuse services who continues in subsequent treatment
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Intensive Substance Abuse Services: Who Continues in Subsequent Treatment?. Kalyani Gopalan Bradley Stein Jane Kogan Mark Sorbero Wes Thompson Academy Health, June 2006. NIMH 5 P30 MH030915-28. Substance Abuse (SA) Disorders Are Chronic Disorders.

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Intensive Substance Abuse Services: Who Continues in Subsequent Treatment?

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Intensive substance abuse services who continues in subsequent treatment

Intensive Substance Abuse Services: Who Continues in Subsequent Treatment?

Kalyani Gopalan

Bradley Stein

Jane Kogan

Mark Sorbero

Wes Thompson

Academy Health, June 2006

NIMH 5 P30 MH030915-28


Substance abuse sa disorders are chronic disorders

Substance Abuse (SA) Disorders Are Chronic Disorders

  • Duration of formal SA treatment associated with better outcomes

  • Individuals initiating intensive SA treatment must move along a continuum of care

  • Risk of drop-out increases when individuals transition between these levels of care


Research questions

Research Questions

  • What are rates of SA treatment after starting a new episode of intensive SA treatment?

  • What is duration of subsequent SA treatment after starting a new episode of intensive SA treatment?

  • What are predictors of SA treatment after starting a new episode of intensive SA treatment?


Analysis variables

Analysis Variables

  • New episode:first intensive SA treatment in measurement period with no intensive treatment for 90 days prior

  • Intensive SA treatment :substance abuse Detox, Residential Rehab or Partial Hospitalization

  • Co-occurring MH SA disorder: primary diagnosis of MH and SA disorder in 1 year prior to measurement period

  • Prior SA treatment: Outpatient or Intensive Outpatient treatment for 30 days before new episode


Any subsequent treatment

Any Subsequent Treatment

  • 2003-4 administrative data from a large regional managed behavioral health organization in Western PA

  • Identified 5096 publicly-insured adults with a new episode of intensive SA treatment

  • Logistic regression for any follow-up

  • Subsequent treatment includes all SA treatment except detox

  • Controlled for age, eligibility, length of stay


46 received subsequent treatment

46% Received Subsequent Treatment

aOR


Subsequent treatment duration

Subsequent Treatment Duration

  • 2345 adults with any subsequent treatment after intensive SA treatment

  • Treatment duration time until no follow up for 30 days

  • Survival Analysis to examine treatment duration

  • Controlled for age, eligibility, length of stay, number of days until first follow up event


30 days median follow up treatment

30 Days Median Follow-up Treatment

Hazard Ratio


Limitations

Limitations

  • Results may not generalize to other systems such as traditional fee-for-service or a staff model HMO

  • Analyses do not consider non-SA treatment providers and services, or non treatment support (e.g AA/NA)

  • Pertinent clinical information not available (i.e. severity of substance abuse, drug of choice, quality of treatment)


Discussion

Discussion

  • 54% of individuals receiving intensive SA care had no formal follow up care within 30 days of index event

  • Females and individuals with prior SA treatment, were more likely to receive follow up care and stay in treatment longer

  • Race/ethnicity was not significant in this analysis


Conclusions and future directions

Conclusions and Future Directions

  • Substantial room to improve SA follow-up care, but it could be worse

  • Interventions to keep consumers in treatment may differ by where consumers start treatment

  • How much does this affect the quality of care and outcomes?


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