Organizational Factors and Patient Characteristics As Predictors of the Availability of Support Services in Methadone Programs

Background and Purpose: In January of 2014 approximately 11 million people with substance use and/or mental disorders will be eligible for health insurance. Given the scarcity of treatment slots in outpatient and residential programs many of these people with an opiate addiction will seek treatment in methadone programs. Research has consistently documented that programs that offer supportive or ancillary services such as social services, employment services, and mental health services have better patient outcomes than those programs that do not. Research has also demonstrated that methadone programs vary widely in the types of services available to their patients. In this paper a set of organizational variables and patient characteristics will be examined in relationship to the availability of social services and mental health services in a sample of methadone programs.

Methods: Data for this study were taken from a sub-section of the National Survey of Substance of Substance Abuse Treatment Services (N-SSATS). The programs that provided methadone services to all of their patients were selected for analysis (n=799). Three dependent variables- provision of social services, employment services and, mental health services- were selected. Using step-wise, logistic regression techniques each of the dependent variables were regressed on organizational variables (ownership, hospital based and size), and Patient characteristics (programs for people with a co-occurring disorder, persons with HIV/AIDS and pregnant women).

Findings: For social services ownership and size were statistically significant showing that large, for-profits were more likely to deliver social services. Also the programs that offered programs for persons with a co-occurring condition and pregnant women were also more likely to offer social services. For employment services only two factors were statistically significant. Large, hospital based programs were more likely to offer employment services. For mental health services the program ownership was important showing that not-for-profits were more likely to provide mental health services as well as programs that offered services to persons with a co-occurring disorder.

Conclusions and Implications: Overall the findings show that methadone programs vary widely on whether they offer social, employment and, mental health services. Organization and finance variables as well as patient characteristics are important predictors of service availability. As the Affordable Care Act (ACA) becomes completely operational it is important for social workers to have an understanding of these organizational dynamics so that they may be more effective advocates for quality services for those with a substance use disorder.