Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations
Department of Medicine, Division of Preventive and Behavioral Medicine
Health Care Surveys; Health Services Accessibility; Health Services Needs and Demand; Humans; Logistic Models; Managed Care Programs; Medically Uninsured; Poverty; Refusal to Treat; Substance Abuse Treatment Centers; administration; Substance-Related Disorders; Uncompensated Care; United States; Waiting Lists
Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Preventive Medicine
OBJECTIVES: This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment.
METHODS: Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients.
RESULTS: In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR, .65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3).
CONCLUSIONS: Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs.
DOI of Published Version
Health Serv Res. 2003 Jun;38(3):887-903. Link to article on publisher's website
Health services research
Friendmann, Peter D.; Lemon, Stephenie C.; Stein, Michael D.; and D'Aunno, Thomas A., "Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations" (2003). Preventive and Behavioral Medicine Publications and Presentations. 188.