Predictors of substance use treatment initiation and engagement among adult and adolescent Medicaid recipients

Figures & data

Table 1. Sample description.

	2010		2015
Characteristic	n	%	n	%
Total eligible sample	198,505		689,565
Adults	132,322	66.7%	584,203	84.7%
Adolescents	66,183	33.3%	105,362	15.3%
New diagnosis of AOD	5,842	2.9%	21,208	3.1%
Adults	4,534	3.4%	19,804	3.4%
Adolescents	1,308	2.0%	1,404	1.3%

Note. AOD = alcohol and other drug dependence.

Figure 1. Rates of treatment initiation and engagement in adults and adolescents, 2010–2015. Solid black line: Adolescent treatment initiation rate. Solid gray line: Adult treatment initiation rate. Dashed black line: Adolescent treatment engagement rate. Dashed gray line: Adult treatment engagement rate.

Table 2. Bivariate tests of treatment initiation and engagement.

	Adult							Adolescents
	No. with new SUD diagnosis	Initiated treatment			Engaged in treatment			No. with new SUD diagnosis	Initiated treatment			Engaged in treatment
Variable	2015Q1Q2	n	%	P value	n	%	P value	2015Q1Q2	n	%	P value	n	%	P value
Total	19,804	6,854	34.6		4,012	20.3		1,404	564	40.2		365	26.0
Gender				.586			.068				.256			.005
Male	11,004	3,827	34.8		2,281	20.7		802	333	41.5		232	28.9
Female	8,800	3,027	34.4		1,731	19.7		602	231	38.4		133	22.1
Race/ethnicity				.513			.011				.464			.943
White	14,226	4,869	34.2		2,828	19.9		791	324	41.0		207	26.2
African American	729	265	36.4		138	18.9		64	29	45.3		19	29.7
American Indian/Alaskan Native	623	227	36.4		113	18.1		74	33	44.6		20	27.0
Asian/Pacific Islander	164	62	37.8		44	26.8		11	3	27.3		2	18.2
Hispanic	1,557	550	35.3		341	21.9		301	119	39.5		78	25.9
Other/unknown	2,505	881	35.2		548	21.9		163	56	34.4		39	23.9
Residence				.888			.535				.171			.006
Urban	12,197	4,226	34.6		2,453	20.1		797	307	38.5		184	23.1
Rural	7,600	2,625	34.5		1,557	20.5		603	255	42.3		179	29.7
Health conditions				<.001			<.001				.209			.101
Any chronic condition	13,574	4,316	31.8		2,161	15.9		537	204	38.0		126	23.5
No chronic condition	6,230	2,538	40.7		1,851	29.7		867	360	41.5		239	27.6
Psychiatric diagnosis				.005			<.001				.697			.055
Yes	4,446	1,460	32.8		746	16.8		310	128	41.3		67	21.6
No	15,358	5,394	35.1		3,266	21.3		1,094	436	39.9		298	27.2
Acute pain diagnosis				<.001			<.001				.136			.002
Yes	6,690	2,072	31.0		983	14.7		403	149	37.0		81	20.1
No	13,114	4,782	36.5		3,029	23.1		1,001	415	41.5		284	28.4
Chronic pain diagnosis				<.001			<.001				.184			.045
Yes	8,653	2,598	30.0		1,275	14.7		300	110	36.7		64	21.3
No	11,151	4,256	38.2		2,737	24.5		1,104	454	41.1		301	27.3
	Mean	Mean	SD		Mean	SD		Mean	Mean	SD		Mean	SD
Age	37.6	36.7	11.7	<.001	35.5	11.0	<.001	15.6	15.6	1.2	.780	15.6	1.2	.562

Table 3. Logistic regression results for treatment initiation.

AOD initiation	Adults			Adolescents
	OR	95% CI	P value	OR	95% CI	P value
Jan–Jun 2010	1.00 (Reference category)			1.00 (Reference category)
Jul–Dec 2010	0.95	0.88, 1.03	.25	0.91	0.78, 1.06	.24
Jan–Jun 2011	1.02	0.95, 1.10	.58	0.99	0.85, 1.15	.90
Jul–Dec 2011	0.94	0.87, 1.01	.11	0.94	0.81, 1.09	.41
Jan–Jun 2012	1.01	0.94, 1.09	.77	0.91	0.78, 1.06	.22
Jul–Dec 2012	0.86	0.80, 0.93	.00	0.88	0.75, 1.02	.08
Jan–Jun 2013	0.84	0.78, 0.91	.00	0.95	0.81, 1.10	.49
Jul–Dec 2013	0.80	0.74, 0.86	.00	0.90	0.77, 1.05	.19
Jan–Jun 2014	0.93	0.87, 1.00	.04	0.92	0.79, 1.07	.30
Jul–Dec 2014	0.83	0.78, 0.89	.00	0.65	0.56, 0.77	.00
Jan–Jun 2015	0.81	0.76, 0.87	.00	0.71	0.61, 0.83	.00
Psychiatric diagnosis	0.97	0.94, 1.00	.02	1.19	1.08, 1.30	.00
Acute pain diagnosis	0.86	0.84, 0.89	.00	0.88	0.81, 0.96	.00
Chronic pain diagnosis	0.83	0.80, 0.85	.00	0.95	0.87, 1.04	.23
Any chronic disease	0.82	0.80, 0.84	.00	0.92	0.86, 0.98	.02
Age	0.99	0.99, 0.99	.00	1.00	0.97, 1.02	.84
Urban residence	1.03	1.00, 1.06	.05	0.93	0.87, 1.00	.04
White male	1.00 (Reference category)			1.00 (Reference category)
Nonwhite male	1.03	0.99, 1.07	.18	0.89	0.82, 0.97	.01
Nonwhite female	1.14	1.10, 1.19	.00	0.72	0.65, 0.80	.00
White female	1.09	1.05, 1.12	.00	0.81	0.74, 0.89	.00

Table 4. Logistic regression results for treatment engagement.

	Adults			Adolescents
AOD engagement	OR	95% CI	P value	OR	95% CI	P value
Jan–Jun 2010	1.00 (Reference category)			1.00 (Reference category)
Jul–Dec 2010	1.01	0.92, 1.11	.82	0.86	0.73, 1.01	.06
Jan–Jun 2011	1.10	1.01, 1.20	.04	1.02	0.87, 1.19	.79
Jul–Dec 2011	0.93	0.85, 1.02	.12	0.87	0.74, 1.02	.08
Jan–Jun 2012	1.05	0.97, 1.15	.23	0.94	0.80, 1.10	.44
Jul–Dec 2012	0.84	0.77, 0.92	.00	0.87	0.74, 1.02	.08
Jan–Jun 2013	0.85	0.78, 0.93	.00	0.91	0.77, 1.07	.24
Jul–Dec 2013	0.73	0.66, 0.80	.00	0.82	0.69, 0.96	.02
Jan–Jun 2014	0.91	0.84, 0.99	.02	0.78	0.67, 0.92	.00
Jul–Dec 2014	0.82	0.75, 0.88	.00	0.58	0.49, 0.69	.00
Jan–Jun 2015	0.78	0.72, 0.84	.00	0.64	0.54, 0.75	.00
Psychiatric diagnosis	0.82	0.79, 0.85	.00	0.87	0.78, 0.96	.00
Acute pain diagnosis	0.75	0.73, 0.78	.00	0.83	0.75, 0.90	.00
Chronic pain diagnosis	0.81	0.78, 0.84	.00	0.95	0.86, 1.05	.32
Any chronic disease	0.59	0.58, 0.61	.00	0.89	0.82, 0.96	.00
Age	0.99	0.98, 0.99	.00	0.98	0.95, 1.01	.19
Urban residence	1.07	1.04, 1.11	.00	0.89	0.83, 0.96	.00
White male	1.00 (Reference category)			1.00 (Reference category)
Nonwhite male	1.01	0.96, 1.06	.70	0.87	0.80, 0.96	.00
Nonwhite female	1.10	1.04, 1.15	.00	0.65	0.59, 0.73	.00
White female	1.11	1.07, 1.15	.00	0.77	0.70, 0.84	.00