Factors Affecting the Initiation of Substance Abuse Treatment in Managed Care

Aims: A long-standing concern of clinicians in addiction treatment is that a large number of individuals who are admitted to treatment do not return to actually begin the program. We identified characteristics that predict treatment initiation.

Design: In-person structured interviews were conducted with consecutive admissions to a large outpatient program (N = 1204), and the health plan's automated registration data were used to determine treatment attendance. We compared those who returned to begin treatment with those who did not.

Setting: The study was conducted at the Chemical Dependency program of a large group model health maintenance organization (HMO).

Participants: Study subjects were individuals age 18 or over admitted to the program.

Measurement: Study variables included DSM-IV alcohol and drug dependence and abuse, Addiction Severity Index problem severity, motivation and treatment entry measures.

Findings: Those who were drug-dependent were less likely to begin treatment than those dependent only on alcohol. Measures of motivation, such as work-place pressures and the patient's perception of the importance of alcohol treatment, predicted starting treatment for individuals who were alcohol-dependent only or alcohol- and drug-dependent. Among patients who were dependent only on alcohol, women were more likely than men to start treatment, and for those who were drug-dependent, being employed and having higher drug severity scores predicted starting treatment.

Conclusions: Screening at intake may identify those at risk of not returning after admission to start treatment. Clinicians may consider making additional efforts during the intake process to engage individuals who are unemployed and have drug (as opposed to alcohol) disorders and less motivation.