Gender Differences in Client Characteristics Associated with Wait Time to Substance Abuse Treatment Entry

Rationale: Among the most commonly cited barriers to substance abuse treatment access among those who seek it is wait time. The longer treatment seekers must wait to receive treatment, the more likely they will dropout. Research suggests that waiting more than a single day significantly decreases the likelihood that a treatment seeker will show up when it becomes available. Despite the importance of wait time as a component of access, few studies with a national scope have attempted to document how long individuals who enter treatment wait to receive it. Moreover, while prior studies point to important gender differences in wait time, little is known about the specific factors that are associated with wait time for men and women.

Methods: The study uses data from the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of substance abuse treatment facilities and clients (Gerstein et al., 1997). The analytic sample consists of 3,142 women from 78 treatment facilities. Descriptive comparisons were made using chi-square tests for categorical variables, and analysis of variance (ANOVA) for continuous variables. Generalized linear mixed modeling was used to determine whether gender moderates the association between client characteristics and the total number of days waited to enter substance abuse treatment. Missing values were specified for these comparisons.

Results: The average wait time for clients in the sample was 30 days. Overall, men reported longer wait times to receive treatment than women. Yet, when accounting for clustering effects across treatment facilities, this gender difference disappeared. No main effect of gender was found when also controlling for client characteristics. However, the results yielded significant interaction effects with gender. In particular, seeking treatment for alcohol and receipt of Medicaid were associated with longer wait times for women. Among both groups, longer wait time was associated with being African-American, being mandated to treatment, and being referred to treatment by the criminal justice system.

Conclusions and implications: The findings of this study suggest that both men and women face significant wait time before receiving substance abuse treatment. Such long waits represent a considerable barrier to access. While on average, men wait longer to receive treatment, it appears that this gender disparity may not be equally distributed across treatment programs. Rather, the study findings suggest that men may be overrepresented in treatment programs with especially prolonged waiting periods. The findings also suggest the presence of an important gender gap in wait time among clients who seek treatment for alcohol and among those who receive Medicaid coverage. Further research is needed to identify the intervening processes that can help explain gender and racial disparities in wait time revealed by the study, and to identify specific interventions—at the levels of policy and practice—that can promote shorter and more comparable wait times for men and women.