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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.

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Intensive Substance Abuse Services: Who Continues in Subsequent Treatment?

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  1. 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

  2. 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

  3. 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?

  4. 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

  5. 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

  6. 46% Received Subsequent Treatment aOR

  7. 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

  8. 30 Days Median Follow-up Treatment Hazard Ratio

  9. 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)

  10. 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

  11. 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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