Association between Legally Mandated Versus Non-Mandated Status of Women on Substance Abuse Treatment Retention

Background: In the United States, substance abusers who are court-mandated to substance use disorder (SUD) treatment receive care alongside those who voluntarily enter treatment. Mandated SUD treatment is commonly used as a treatment engagement strategy by the criminal justice (CJ) system with women diagnosed with a SUD in lieu of prosecution. Yet, results and efficacy of CJ mandated versus non-mandated treatment are mixed on treatment retention, while few studies have assessed the efficacy of CJ mandated treatment with women. Understanding how pretreatment characteristics and mandated status interplay on treatment retention may inform improved treatment strategies for mandated and non-mandated women in SUD treatment.

Methods: Data utilized in this study is a subset of data from a parent study consisting of N=245 women at a women’s substance abuse treatment program. Of the 245 participants in the study, average age was 32.21 years, and the majority were Hispanic (57.55%) followed by equal percentages of White (20.41%) and African-American women (20.41%), and those classified as Other race/ethnicity being (1.63%).

Using SAS 9.4, a hierarchal regression comparing 2 models was used for examining model building. The dependent variable (days in treatment) was examined with primary independent variable (mandated – yes/no). Independent variables including stress sum scores, number of mental health diagnoses, age and number of children in legal or not in legal custody were then added to the regression analysis. Based on F-test comparison, the most parsimonious model was selected and analyzed.

Results: Several significant associations were found with dependent variable 'days in treatment,' including being mandated, increased stress scores, no mental health diagnoses and age. Controlling for all other variables in the model there is a 12% increase in retention as measured by days in treatment for those who were mandated versus non-mandated women in SUD treatment. There is a 1% decrease in days in treatment for each increment (range = 0-21) increase in stress score. There was a 20% decrease in days in treatment for those with no mental health diagnosis as compared to those with 2 mental health diagnoses or more.

Implications: While being mandated into substance abuse treatment is an acceptable predictor of increased days in treatment, thus retention, the results of this study show that this may not apply to women with higher stress sum scores, no mental health diagnoses, or to women who still have children in their legal custody under the age of 18 years of age. Overall, these findings support the need for tailoring individualized treatment for women in substance abuse treatment. Specific strategies which need to be addressed include assessing for the unique treatment responsivity needs of; 1) mandated versus non-mandated women who enter SUD treatment; 2) women who score high on the stress diagnostic scale; 3) children in their legal custody at time of treatment and; 4) substance use severity. Once assessed for these predictors, personalized treatment plans may increase treatment retention and outcomes among women mandated and non-mandated into SUD treatment.