Addressing Length of Stay in Substance Abuse Treatment to Predict Successful Completion

Background and Purpose:  Substance abuse is a significant health concern to social work researchers and practitioners.  Only 2.5 million people of an estimated 22.7 million receive the needed treatment, and of those who receive it, more than one-third do not complete treatment (SAMHSA, 2014).  Although new research strategies and interventions are improving treatment results, substance abuse remains a significant global problem, and reducing and preventing its consequences is a Grand Challenge for Social Work (Begun et al., 2016).  The purpose of our study was to investigate factors that affect the length of a client’s stay in substance abuse treatment as a path to treatment completion.  Specifically, our study tested the following hypotheses:

 

1. The length of stay in substance abuse treatment is positively associated with successful treatment completion.
2. The length of stay in substance abuse treatment is predicted by the wait-time to enter treatment, cost of treatment, prior treatment episodes, frequency of drug use before treatment, age at first use, and having health insurance.

Methods:  This study is a secondary analysis of the 2011 Treatment Episode Datasets—Discharge (TEDS-D) data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA).  The data includes discharge information from all public and private treatment facilities receiving public funding throughout the United States.  We used a statewide subsample of clients ages 18 and older from non-intensive outpatient treatment, ambulatory intensive outpatient treatment, and inpatient treatment settings (n=10,814). The data were analyzed with a path model using Stata v.14.1 and Mplus v.7.0.

Results:  How long clients stayed in substance abuse treatment had a statistically significant effect on their successful completion of treatment (p<0.001).  Results showed that clients are more likely to stay longer in treatment if treatment is free and when their wait-time into treatment is short (p<0.001).  Further, the more frequent their substance use before treatment, the shorter their stay in treatment is likely to be (p<0.001).  Also, prior treatment episodes approached significance (p<0.056), suggesting that an increased amount of prior substance abuse treatment may lead to a shorter length of stay.  Age at first use and having health insurance were not significant predictors of a client’s length of stay in treatment.

Conclusions and Implications:  The longer a client stays in substance abuse treatment, the higher the probability they complete treatment.  To facilitate longer stays in substance abuse treatment, policy makers, administrators, and practitioners need to find ways to facilitate shorter wait times for getting people into treatment, and find ways to make treatment affordable.  Frequency of use and prior substance abuse treatment history are risk factors that can affect length of stay, and treatment providers should be mindful of these high-risk clients and their needs to ensure greater success.  The results of this study provide evidence that can inform innovative strategies for closing the health gap among substance abuse treatment clients, which can lead to broad gains in the health of our society (AASWSW, 2017).