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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

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
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
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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