Admissions to detoxification after treatment: Does engagement make a difference?

ABSTRACT

Background: Treatment engagement is a well-established performance measure for the treatment of substance use disorders. This study examined whether outpatient treatment engagement is associated with a reduced likelihood of subsequent detoxification admissions. Methods: This study used administrative data on treatment services received by clients in specialty treatment facilities licensed in Massachusetts. The sample consisted of 11,591 adult clients who began an outpatient treatment episode in 2006. Treatment engagement was defined as receipt of at least 1 treatment service within 14 days of beginning a new outpatient treatment episode and receipt of at least 2 additional treatment services in the next 30 days. The outcome was a subsequent detoxification admission. Multilevel survival models examined the relationship between engagement and outcomes, with time to detoxification admission as the dependent variable censored at 365 days. Results: Only 35% of clients met the outpatient engagement criteria, and 15% of clients had a detoxification admission within a year after beginning their outpatient treatment episode. Controlling for client demographics, insurance type, and substance use severity, clients who met the engagement criteria had a lower hazard of having a detoxification admission during the year following the index outpatient visit than those who did not engage (hazard ratio = 0.87, P < .01). Conclusions: Treatment engagement is a useful measure for monitoring quality of care. The findings from this study could help inform providers and policy makers on ways to target care and reduce the likelihood of more intensive services.

KEYWORDS:

• Performance measures
• substance abuse treatment
• treatment engagement

Acknowledgments

The authors would like to thank Hermik Babakhanlou-Chase of the Bureau of Substance Abuse Services (BSAS) in Massachusetts and Andrew Hanchet, formerly at BSAS, for their assistance with the development of the data set. Jennifer Miles and Timothy Creedon of Brandeis University assisted with the preparation of the manuscript.

Author contributions

Dr. Acevedo designed the study, conducted the statistical analysis, and wrote the first draft of the manuscript. Dr. Garnick contributed to the design of the study and interpretation of the statistical analyses, and critical revision of the manuscript. Dr. Ritter assisted with the analyses design and interpretation of findings and edited the manuscript. Drs. Lundgren's and Horgan's contributions included the interpretation of the data analyses and critical revision of the manuscript. All authors contributed to and have approved the final manuscript.

Funding

This study was supported by Award Numbers F31AA018246 (Principal Investigator [PI]: Acevedo) and T32AA007567 (PI: Horgan) from the National Institute on Alcohol Abuse and Alcoholism. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health. The funding entity had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The authors declare that they have no conflicts of interest.