Impact of Access Services to Residential and Non-Residential Specialty Substance Abuse Treatment

Background: Examining service access in substance abuse treatment across different service settings is important in light of the dramatic increase in non-residential treatment over the past two decades. The substance abuse treatment system changed significantly in the 1990's as traditional 28-day hospital-based treatment programs closed and non-residential, outpatient programs became more available. The greater availability of outpatient programs increased concern with their accessibility and with the need to address barriers to treatment due to lack of transportation and child care. In this study, the service delivery model included access services, targeted substance abuse treatment services, matched health and social services and client-provider relationship. The purpose of this study was to (1) examine the extent to which access services were received in residential and non-residential settings, and (2) compare the impact of access services outcomes of treatment duration and post-treatment substance use in both settings.

Methods: The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of U.S. substance abuse treatment programs and their clients with an analytic sample of 59 service delivery units and 3,027 clients. Structural equation modeling (SEM) was used to assess the structural relations and causal connections among treatment process variables of service access, targeted services, matched services, client-provider relationship and service outcome variables of treatment duration and post-treatment substance use. Organizational factors, and client characteristics were used as control variables. The analytic sample consists of 3027 clients from 59 service delivery units.

Results: Standardized path coefficients indicate that in outpatient non-residential settings, access services directly predict receipt of substance abuse services (B=.12, p<.05) and indirectly predict longer treatment duration and reduced post-treatment substance use. Client provider relationship mediates the relationship between substance abuse counseling and post-treatment substance abuse and directly predicts reductions in post-treatment substance use (B=-.11, p<.05). In comparison, in residential settings, access services had no direct or indirect effect on treatment outcome.

Conclusions and implications: The findings point to the value of providing access services to insure receipt of substance abuse services and increase treatment duration and ultimately to reduce post-treatment substance use, particularly in outpatient non-residential settings.