Two Separate Tracks? A National Multivariate Analysis of Differences Between Public and Private Substance Abuse Treatment Programs

Abstract

Objective: This study describes differences between public and private substance abuse treatment programs. Method: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. Results: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. Conclusions: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local governments. Programs operated by nonprofit agencies had characteristics that placed them between private for-profit and public programs. State and local agencies are contracting with private managed behavioral health care organizations to provide substance abuse treatment and other mental health care. The characteristics of for-profit programs may represent the future direction of substance abuse treatment.