Substance use disorder treatment success: assessing patient-reported use improvement and provider-evaluated treatment completion

Abstract

Background

Provider-evaluated substance use treatment completion and client-reported substance use improvement are standards in determining treatment success. The relationship between these two outcomes is anecdotally understood in practice. However, the relationship has not been empirically determined and factors related to provider/client conflicting assessments are unknown. This study investigates treatment success by investigating consensus and conflict between improvement and completion in a large national sample.

Method

The present study is a cross-sectional retrospective evaluation of US substance use treatment episodes from facilities receiving public funding from 2015 to 2019 (N = 5,047,714). Episodes were mostly male (64.5%), aged 25–34 (34.4%), and White (58.5%). Conflict, consensus, and client factors associated with conflicting outcome evaluations were compared with differences in proportions and their 95% confidence intervals. Logistic regression was used to predict completion from improvement, adjusting for covariates.

Results

For absolute percentages, clients and providers were in consensus in 48.3% of all episodes, 32.5% were in conflict, and 19.2% were missing. The adjusted analysis significantly predicted completion from improvement (aOR = 2.18, 95% CI = 2.17, 2.19). Importantly, outcome conflict demonstrated absolute meaningful associations with problem substance, referral source, employment status, service setting, and supplemental mutual-help group attendance.

Conclusions

Completion and improvement are somewhat associated, but most likely represent separate factors of treatment success. Addressing factors associated with outcome conflict may improve client and provider consensus and increase successful recovery. Policies and programs can set standards aligned with a uniform definition of success accounting for use improvement.

Keywords:

• Outcome assessment
• employment
• self-help
• referral source

Disclosure statement

TAF reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, and a grant from Mitsubishi-Tanabe, outside the submitted work; TAF has a patent 2018-177688 pending. All the other authors report no competing interests.

Data availability statement

Data for this study are available at https://www.datafiles.samhsa.gov/data-sources.

Additional information

Funding

ES is supported by the Japan Society for the Promotion of Science (JSPS) grants P19110 and 19F19110. EGO is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility and by the NIHR Oxford Health Biomedical Research Center grant BRC-1215-20005. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health. JSPS and NHIR had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.