Examination of Statewide Public Substance Use Disorder (SUD) Treatment in One Southeastern State: The Impact of Demographic Factors on Substance Use

Purpose: Disparities exist in substance use disorder (SUD) treatment access. However, for those who successfully access public SUD treatment, it is unknown if statewide administrative data samples will indicate that treatment is differentially effective for different demographic groups. Utilizing administrative records of all public SUD clients in one southeastern state, this study compares the effectiveness of SUD treatment over time by race, marital status, and gender in reducing self-reported substance use.

Methods: For fiscal year 2013, statewide administrative records of all individuals receiving public SUD treatment in one southeastern state were utilized (n=17,689). These clients were predominantly male (66.3%; 33.7% female), never married (57.7%; 18.1% married, 24.2% previously married), and White non-Hispanic (64.87%; 30.56% Black non-Hispanic, 3.1% Hispanic, 1.4% other). Treatment modalities (e.g., inpatient, outpatient) were grouped together for analysis. SUDs were measured at three time points (admission, discharge, follow-up) utilizing self-reported data on the number of days in the past 30 days that the individual used alcohol, used alcohol to intoxication, or used illegal drugs. Utilizing a model building approach, a series of two-level linear growth models were run for each dependent variable (alcohol use, alcohol use to intoxication, illegal drug use). Models assessed for the main effect of time plus the effect of race, marital status, gender, and number of treatment days. Additional models examined the interaction of time with each independent variable (race, marital status, gender) while controlling for number of treatment days. Analyses were run using PROC MIXED in SAS v9.4.

Results: On average, while controlling for client demographics and days of treatment, clients reported using alcohol 13 days (b=13.61) at the time of admission. Using alcohol decreased on average almost five days (b=-4.83) over time. However, this change was not consistent across patient race (reference White non-Hispanic, b=-0.93 Black non-Hispanic) and marital status (reference never married, b=-0.74 married, b=-0.92 previously married). While controlling for client demographics and days of treatment, clients reported using alcohol to intoxication approximately 17 days (b=17.32) on average at the time of admission but this decreased on average by almost six days (b=-5.86) over time. This change was not consistent across race (reference White non-Hispanic; b=-0.47 Black non-Hispanic, b=2.79 Hispanic), marital status (reference never married; b=-0.62 married, b=-1.69 previously married), and gender (reference male; b=-0.62 female). While controlling for client demographics and days of treatment, clients reported using illegal drugs an average of 21 days (b=21.11) at time of admission. Using illegal drugs decreased an average of seven days (b=-6.87) over time. The change in illegal drug use did not vary by client race, marital status, or gender.

Conclusions/Implications: Following treatment, clients self-reported decreases in alcohol use, alcohol use to intoxication, and illegal drug use. For alcohol use and alcohol use to intoxication, reductions varied based on demographics. Results support the need for culturally-responsive SUD treatment. Future work should explore the mechanisms through which these demographic disparities are created and to test if these disparities exist across all treatment types.