Sociodemographic Correlates of Heroin Treatment Utilization & Completion in Connecticut: Intervention Implications

Background: National epidemiological and treatment statistics suggest that heroin use and addiction are on the rise among young adults.  The CDC Wonder data indicate a five-fold increase in the number of deaths from heroin overdose in 2013 compared with 2012.  The NSDUH survey indicates that in 2012, the number of young adults using heroin for the first time doubled from what it was in 2006. TEDS data show a rapidly increasing utilization of treatment services for heroin among young adults. TEDS data suggest considerable ethnic variation in heroin treatment utilization. For Hispanic subgroup, Puerto Ricans, heroin is the primary substance of abuse in most drug treatment episodes. Research suggests the importance of culturally sensitive approaches to addressing heroin and other addictions in Puerto Ricans and other ethnic minority patients.  As a first step in the prevention and intervention planning process, we need a better understanding of socioeconomic differences and correlates in treatment trends and outcomes.  This presentation examines these trends in one particular state, Connecticut, a state where there is a relatively large Puerto Rican minority population and where there are comprehensive data about heroin treatment service utilization and outcomes.  

Methods:   We examined fiscal year 2014 administrative treatment records for adults seeking treatment from facilities operated or funded by Connecticut Department of Mental Health and Substance Abuse (DMHAS).  We focused on all clients who had an active treatment episode and whose primary drug at admission was heroin. Data were obtained from the agency’s electronic record keeping system that captures admissions and treatment data for clients served across the state.

Results: Compared to Whites and African Americans, Hispanic clients were more likely to identify heroin as primary drug at admission.  Nearly four in ten Hispanic clients identified heroin as their primary drug at admission.  Among the 17,679 clients who had an active treatment episode during this period, and reported heroin as their primary drug at admission, a majority was White (64.1%), male (66.4%), with an average age of 39.2 (SD=11.85).  Twenty-four percent of the clients were Hispanic, and two-thirds of these Hispanic clients were Puerto Rican.   Almost three-quarters of the client sample (71.1%) had received Methadone Maintenance treatment; 25.7% had at least one episode of medically monitored detox; and 21.6% had outpatient treatment. When treatment outcomes were examined using logistic regression analysis, we found that Hispanic heroin users were less likely than Whites to complete their treatments successfully (OR=0.89, S.E.=0.06, p=0.001).   The data also suggest that males were more likely than females to successfully complete their treatment (OR=1.08, S.E.=0.03, p=0.023).  

Implications: Despite the salience of heroin addiction among those identifying as Hispanic and Puerto Rican, treatment is clearly less effective within this subgroup.  Given the persistence and prevalence of heroin addiction among Hispanics nationally and in Connecticut, these findings underscore the need to understand the unique sociocultural factors that may be associated with treatment non-completion.  The findings also suggest the need for the design, implementation, and evaluation of more culturally competent approaches to heroin treatment and related services for Hispanic patients.