Friday, 14 January 2005 - 10:00 AM

This presentation is part of: Addressing Intimate Partner Violence, Drug Use, and HIV Among Men in Drug Treatment

Men in Drug Treatment: Are There Different Patterns of Supplemental Service Utilization?

Background: The high prevalence of health and psychosocial needs among methadone treatment patients has prompted efforts to supplement methadone treatment with additional services. In spite of their demonstrated value, the provision of additional services within methadone treatment programs has decreased in recent years. To compensate, the trend has been to refer clients to off-site service providers, herein referred to as supplemental services. Research has generally focused on linking supplemental service utilization to drug treatment outcomes. Although there is a burgeoning body of empirical literature providing an understanding supplemental service utilization itself, there is a need to characterize service utilization beyond a dichotomous "yes or no" description. Using data from a random sample of men attending methadone maintenance treatment programs (MMTPs), we tested hypotheses regarding whether (a) those who regularly (i.e., Ан1 visit/month) utilized supplemental services differed from those who did not attend any supplemental services; and (b) those who regularly utilized supplemental services differed from those who occasionally (i.e., >0 but <1 visit/month) utilized supplemental services.

Methods: Randomly selected men (N=780) attending MMTPs in New York City provided self-reported data on sociodemographics (e.g., age, race/ethnicity, health insurance); number of stressful life events (e.g., being mugged, homeless periods, life-threatening illness) using the Life Events Questionnaire; and use of supplemental services (e.g., primary/emergency healthcare, mental health, social work) using the Treatment Services Review. The latter two instruments were modified and tailored for urban, poverty-stricken communities and assessed events/behaviors over the preceding 6 months. MANCOVA and multinomial logistic regression analyses were used to simultaneously test hypotheses regarding differences among those who reported regular, occasional, and no service utilization.

Results: The median age of participants was 46 years, with 35% identifying as African American, 46% as Latino, and 13% as white. The number of SLEs ranged from 0 to 11 (median=1.0). About one-fourth (29%) of the participants utilized supplemental services. Compared to those who reported no supplemental service utilization, those who regularly attended supplemental services were less likely to be African American (p = .06) or Latino (p = .04) compared to white, have achieved a higher level of education (p < .01), more likely to have health insurance (p < .01), have been in methadone treatment longer (p = 03), and experienced a greater number of stressful life events (p < .01). No significant differences were observed when comparing regular vs. occasional supplemental service utilization. Furthermore, all estimates that were significant for regular vs. no service utilization changed by at least 50% and ranged up to 300% when comparing regular vs. occasional service utilization.

Conclusions: These findings suggest that there may be individual and contextual dynamics that lead to different patterns of supplemental service utilization among men in methadone treatment. The data are consistent with a model of service utilization in which the effort and/or threshold to initiate service utilization are higher than those required to continue service utilization. Additional implications for both social work research and practice in drug treatment settings will be discussed.

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