Stability in a large drug treatment system: Examining the role of program size and performance on service discontinuation

Abstract

Background Little is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States. Methods This study relied on multi-year (2006–2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods. Results Sixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services. Conclusions Program size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises .

Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study

“…Previous studies have shown a lack of stability in treatment facilities in Los Angeles County, with 62% of programs closing in a 5-year period [ 40 ]. Although methadone programs were found to be more stable, the frequency of closures can be tied to significant changes in EDT to treatment.…”

Understanding the role of financial capacity in the delivery of opioid use disorder treatment

“…The current substance use disorder (SUD) treatment system has struggled to meet the service needs of an increasingly diverse population [ 26 , 47 ], particularly those suffering from opioid use disorder (OUD; [ 25 , 30 ]. Because many SUD treatment programs are small and financially unstable, they face high risks of discontinuing services or reducing the quality of care [ 23 , 33 ]. Furthermore, low revenues and net assets are often reported as barriers to financing comprehensive services like mental health and social services [ 31 , 43 , 47 ].…”