The Mediating Roles of Psycho-Social Strengths to Substance Use Disorder Treatment Completion

Background: Research on substance use disorder (SUD) treatment dropout has highlighted the adverse impact it can have on clients, including legal and financial issues, relapse, and unfavorable physical and behavioral health conditions. Previous research has identified factors associated with higher treatment completion rates for adults with SUD, such as substance type , education, employment status, health insurance, and referral source. However, little research has examined the interrelationships, including direct and indirect/mediation effects, among legal system involvement, psycho-social factors related to personal strengths, improved behavioral health needs, and SUD treatment completion. Therefore, the primary purpose of this study is to examine the direct and indirect effects of measured and latent variables on SUD treatment completion.

Methods: Using a sample from one Midwestern state, we identified 3,627 young adults (aged 18-25; 83.2% White; 11.7% Black; 4.7% Hispanic; 52% female; 62.5% lived in urban areas) receiving publicly funded behavioral health services. Thirty percent were referred by the court/justice system. We compared the treatment completion of these young adults to those referred by sources other than the court/justice system (e.g., individual/self-referral, child protective services, health care, and other community referrals). Thirty-three percent of the sample used opioids as a primary, secondary, or tertiary substance in SFY 2021.We conducted a logistic regression model to examine the unique associations of gender, race/ethnicity, urban/rural residence, psycho-social strengths, court/justice system involvement, opioid use disorder, improved behavioral health needs, and SUD treatment completion. We then applied structural equation modeling (SEM) to detect the mediating role of psycho-social strengths in behavioral health needs improvement that led to SUD treatment completion.

Results: Using MLE in AMOS 28, the logistic regression model identified unique associations of legal system involvement, strengths, and improvement in behavioral health needs with SUD treatment completion. The SEM estimation terminated normally within the default convergent criterion (Chi-square = 95.203, df = 12, p = 0.000; RMSEA = 0.044, CI = (0.036, 0.052); CFI = 0.97; TLI = 0.923), and these model fit values exceed the criteria recommended by Hu and Bentler (1999), confirming that positive attributes in strengths mediated the effect of court/justice involvement on improvement in behavioral health needs that led to SUD treatment completion.

Discussion: While there were significant differences in completing SUD treatment between White and Black participants, the SEM model confirms that legal system involvement and the mediating role of psycho-social strengths were critically important in detecting improvement in behavioral health needs and SUD treatment completion, regardless of race. Psycho-social factors related to strengths include social connectedness, optimism, job history, and resilience. Based on these results, implications for social work practice and future research are discussed.