Individual, Clinical, and Structural Predictors of Wait Time for Substance Use Treatment Among Pregnant Individuals

Background and Purpose. Substance use during pregnancy is linked to a range of adverse outcomes and complications for both mothers and infants and yet substance use treatment during pregnancy remains underutilized. Although quicker access to treatment has been linked with higher rates of treatment completion, there is limited research on the wait times for accessing treatment specifically among pregnant individuals and the systemic factors that influence wait times. This study aimed to better understand clinical and structural factors associated with wait times for accessing substance use treatment among pregnant individuals. We hypothesized that structural factors such as experiencing homelessness and referrals from criminal justice systems would be significantly associated with longer wait time to treatment.

Methods. This study analyzed TEDS-A data – publicly available administrative data for individuals accessing substance use treatment in settings that receive public funding The sample consisted of 3,192 pregnant people aged 18 to 44. We employed descriptive statistics to summarize the variables and participants' characteristics (age, race, referral source, use of medication-assisted treatment, mental health status, and housing status). Then, we performed a regression analysis to examine whether treatment wait times among pregnant women were influenced by structural factors, like housing status and referral source, while controlling for age and race.

Results. Most admissions in our sample were aged 30 to 34 (n=1,042; 32.64%), and white (n=2471; 77.41%). Self-referrals comprised 50.34% (n=1607) of the sample followed by court/criminal justice (22.3%; n=712). Sixty-eight percent (n=2165) were living in independent living situations, with the remaining living in dependent situations or experiencing homelessness. Most admissions happened on the same day (64.88%; n=2071), followed by 1 to 7 days (21.40%; n=683). The multinominal-logistic regression model was statistically significant (p < .001), indicating that the predictors explain the differences in wait times. Pregnant admissions in independent living arrangements had a significantly lower likelihood of waiting 8–14 days (OR =- 0. 79, p < .001, CI=-1.23, -.45) and 15–30 days (OR=- 0. 51, p = .026, CI=-1.03, -.13) compared to people in dependent living situations or experiencing homelessness. Referrals from a court/criminal justice system or a substance use program significantly increased the chances of waiting longer than a week for treatment when compared to self-referral.

Conclusions and Implications. The study found that structural and clinical factors influence wait time for substance use-related treatment among pregnant people, and that pregnant people in independent living situations were more likely to access treatment faster than those with unstable housing. Self-referral increased the chances for quicker admission than other referral sources, and prior history of mental and substance abuse affected wait time. These findings indicate the importance of addressing the structural and systemic barriers preventing pregnant people experiencing homelessness from accessing treatment. Ensuring housing stability reduces wait times and facilitates timely substance use treatment. This, in turn, can enhance treatment engagement and improve health outcomes for this vulnerable population.