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ABSTRACT
Background: Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services. Objectives: The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities. Methods: Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed. Results: Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities. Conclusions/Importance: To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.
Additional information
Notes on contributors
Nicole R. Schultz
Nicole R. Schultz, M.A., is a clinical doctoral student at Auburn University. She received her M.A. at the University of the Pacific. Her research interests include measurement and assessment of substance use disorders. Specifically, she is interested in objective measures of alcohol use, such as the free-pour assessment, to understand individuals' typical drinking patterns and standard drink size knowledge. Her other research interests include examining environmental variables that systematically influence both self-reported and actual drinking behavior, and social norms interventions for substance use.
Rociel Martinez
Rociel Martinez, Psy.D., is a Postdoctoral Fellow at Counseling and Psychological Services at UC Santa Barbara, where she also completed her Predoctoral Internship. She graduated from the PGSP-Stanford Psy.D. Consortium in Palo Alto, CA with her doctorate in Clinical Psychology, and is a generalist by practice, but is currently pursuing additional training related to clinical treatment of interpersonal violence including sexual assault, domestic violence, and childhood sexual abuse, in both individual and group therapy. She is also interested in training and supervision.
Michael A. Cucciare
Michael A. Cucciare, Ph.D., is a core investigator at the VA Health Services Research & Development Center for Mental Healthcare and Outcomes Research and the South Central MIRECC (VISN 16) at the Central Arkansas Veterans Healthcare System in Little Rock, Arkansas. He is also an Assistant Professor in the Department of Psychiatry at the University of Arkansas for Medical Sciences. His research interests include addiction focused health services research in rural and Veteran populations.
Christine Timko
Christine Timko, Ph.D., is a Senior Research Career Scientist, Health Services Research and Development Service, Department of Veterans Affairs, and Consulting Professor, Psychiatry and Behavioral Sciences, Stanford University School of Medicine. Within her addiction research at the Center for Innovation to Implementation in Menlo Park, CA, Dr. Timko's interests are evidence-based practices to facilitate transitions between levels and types of health care, such as detoxification to substance use disorder treatment, and helping family and friends of individuals with unhealthy substance use.