Unmet need for Substance Abuse Treatment of Adults in Massachusetts

Did paying drugs misuse treatment providers for outcomes lead to unintended consequences for hospital admissions? Difference-in-differences analysis of a pay-for-performance scheme in England

AIMS

To estimate how a scheme to pay substance misuse treatment service providers according to treatment outcomes affected hospital admissions.

DESIGN

A controlled, quasi-experimental (difference-in-differences) observational study using negative binomial regression.

SETTING

Hospitals in all 149 organisational areas in England for the period 2009-2010 to 2015-2016.

PARTICIPANTS

572 545 patients admitted to hospital with a diagnosis indicating drug misuse, defined based on International Classification of Diseases 10th Revision (ICD-10) diagnosis codes (37 964 patients in 8 intervention areas and 534 581 in 141 comparison areas).

INTERVENTION AND COMPARATORS

Linkage of provider payments to recovery outcome indicators in 8 intervention organisational areas compared with all 141 comparison organisational areas in England. Outcome indicators included: abstinence from presenting substance, abstinent completion of treatment and non-re-presentation to treatment in the 12 months following completion.

MEASUREMENTS

Annual counts of hospital admissions, emergency admissions and admissions including a diagnosis indicating drugs misuse. Covariates included age, sex, ethnic origin and deprivation.

FINDINGS

For 37 245 patients in the intervention areas, annual emergency admissions were 1.073 times higher during the operation of the scheme compared with non-intervention areas (95% CI = 1.049; 1.097). There were an estimated additional 3 352 emergency admissions in intervention areas during the scheme. These findings were robust to a range of secondary analyses.

CONCLUSION

A programme in England from 2012 to 2014 to pay substance misuse treatment service providers according to treatment outcomes appeared to increase emergency hospital admissions.

Measuring Unmet Demand for Alcohol and Other Drug Treatment: The Application of an Australian Population-Based Planning Model

OBJECTIVE

The estimation of demand for treatment is one of the important elements in planning for alcohol and other drug treatment services. This article reports on a demand-projection model used in Australia to estimate the extent of unmet treatment demand by drug type.

METHOD

The model incorporated the prevalence of substance use disorders (by drug type and age), with the application of a severity distribution, which distributed the substance abuse disorders into three disability categories: mild, moderate, and severe. The application of treatment rates derived from expert judgments reflecting the proportion of people within disability categories who would be suitable for, likely to seek, and benefit from treatment. Sensitivity analyses incorporating variations to the severity distributions and treatment rates were applied, along with adjustment for polydrug use.

RESULTS

The estimate for treatment demand for Australia varied between a low of 411,740 people and a high of 755,557 people. The most sensitive parameter is the expected treatment-seeking rate. Given that approximately 200,000 to 230,000 people are currently in treatment, this represents a met demand of between 26.8% and 56.4%.

CONCLUSIONS

There is insufficient alcohol and drug treatment available to meet the demand in Australia, despite Australia's relatively high met demand, when compared with other countries.

Failure to get into substance abuse treatment

Among substance abusers in the US, the discrepancy in the number who access substance abuse treatment and the number who need treatment is sizable. This results in a major public health problem of access to treatment. The purpose of this study was to examine characteristics of Persons Who Use Drugs (PWUDs) that either hinder or facilitate access to treatment. 2646 participants were administered the Risk Behavior Assessment (RBA) and the Barratt Impulsiveness Scale. The RBA included the dependent variable which was responses to the question "During the last year, have you ever tried, but been unable, to get into a drug treatment or detox program?" In multivariate analysis, factors associated with being unable to access treatment included: Previously been in drug treatment (OR=4.51), number of days taken amphetamines in the last 30days (OR=1.18), traded sex for drugs (OR=1.53), homeless (OR=1.73), Nonplanning subscale of the Barratt Impulsiveness Scale (OR=1.19), age at interview (OR=0.91), and sexual orientation, with bisexual men and women significantly more likely than heterosexuals to have tried but been unable to get into treatment. The answers to the question on "why were you unable to get into treatment" included: No room, waiting list; not enough money, did not qualify, got appointment but no follow through, still using drugs, and went to jail before program start. As expected, findings suggest that limiting organizational and financial obstacles to treatment may go a long way in increasing drug abuse treatment accessibility to individuals in need. Additionally, our study points to the importance of developing approaches for increasing personal planning skills/reducing Nonplanning impulsivity among PWUDs when they are in treatment as a key strategy to ensure access to additional substance abuse treatment in the future.

Co-Morbidities Among Persons With Substance Abuse Problems

This article uses the behavioral model for vulnerable populations to evaluate the use of substance abuse treatment services among a sample of 926 substance abusers with one or more vulnerable health designations. A two-stage hierarchical logistic regression was completed to determine the influence of vulnerable and traditional need factors on the probability of receiving substance abuse treatment. Among traditional covariates, increased odds of receiving substance abuse treatment are associated with being either non-Hispanic White, Hispanic, having an income > US$5,000, and having a regular source of care. Among vulnerable covariates, injection drug use (odds ratio [OR] = 2.19, confidence interval [CI] = [1.46, 3.27]) and the receipt of public benefits (OR = 1.98, CI = [135, 2.92]) remain independent risk factors for the receipt of substance abuse treatment. Many who experience substance abuse disorders can also experience a multitude of other vulnerable health classifications, suggesting the need for a comprehensive, multidisciplinary approach to the treatment of substance use disorders.

Unmet need for treatment for substance use disorders across race and ethnicity

BACKGROUND

The objective was to analyze disparities in unmet need for substance use treatment and to observe variation across different definitions of need for treatment.

METHODS

Data were analyzed from the 2002 to 2005 National Survey of Drug Use and Health and the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regressions estimated the likelihood of specialty substance use treatment across the two data sets. Parallel variables for specialty, informal and any substance abuse treatment were created. Perceived need and normative need for substance use treatment were defined, with normative need stratified across lifetime disorder, past twelve month disorder, and heavy alcohol/any illicit drug use. Treatment rates were analyzed, comparing Blacks, Asians and Latinos to non-Latino whites across need definitions, and adjusting for age, sex, household income, marital status, education and insurance.

RESULTS

Asians with past year substance use disorder had a higher likelihood of unmet need for specialty treatment than whites. Blacks with past year disorder and with heavy drinking/illicit drug use had significantly lower likelihood of unmet need. Latinos with past year disorder had a higher likelihood of unmet need for specialty substance abuse treatment. Asians with heavy drinking/illicit drug use had lower likelihood of unmet need.

CONCLUSIONS

The findings suggest that pathways to substance abuse treatment differ across groups. Given high rates of unmet need, a broad approach to defining need for treatment is warranted. Future research to disentangle social and systemic factors from factors based on diagnostic criteria is necessary in the identification of need for treatment.

Patterns of substance involvement and criminal behavior: a gender-based cluster analysis of Pennsylvania arrestees

Recent drug-crime scholarship has underscored the importance of conducting disaggregated research that focuses on the consistencies and variations between subcategories of drug misuse and criminal activity and, further, how these associations may vary across sociodemographic and cultural boundaries. The research presented in this article used cluster analysis to independently classify male and female arrestees based on their arrest charges and substance-specific indicators of initiation, use, dependence, and treatment need. The data come from Pennsylvania's Substance Abuse and Need for Treatment Among Arrestees study conducted as part of the State Treatment Needs Assessment Program. Five groups were identified in both the male and female cluster analyses. The results reveal both important differences and strong similarities in the drug-crime typologies of male and female arrestees. Given these findings, implications are discussed for developing and targeting responsive treatment services that match the particular risks and needs of drug-involved offenders.

Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective

OBJECTIVES

This study estimates the costs to society of prescription opioid analgesic (RxO) abuse in the United States.

METHODS

Costs associated with RxO abuse were grouped into healthcare, criminal justice, and workplace categories. Costs were estimated by either (1) a quantity method that multiplies the number of RxO abusers derived from various national surveys by the estimated per abuser cost, or (2) an apportionment method that starts with overall (ie, prescription and nonprescription) drug abuse costs for a cost component (eg, police protection) and apportions the share of costs based on the prevalence of RxO abuse relative to overall drug abuse. Medical costs in excess of those for otherwise similar nonabusers were based on an analysis of a large administrative claims database for an employed population using multivariate regression methods.

RESULTS

A lower bound estimate of the costs of RxO abuse in the United States was 8.6 billion dollars in 2001 (or 9.5 billion dollars in 2005 dollars). Of this amount, 2.6 billion dollarswere healthcare costs, 1.4 billion dollars were criminal justice costs, and 4.6 billion dollars were workplace costs.

CONCLUSIONS

The costs of RxO abuse represent a substantial economic burden. Rising trends of RxO abuse suggest an escalating economic and public health burden in coming years in the United States, and potentially, elsewhere.