Age and Days Waiting to Enter Treatment Facility are Significant Predictors of the Number of Previous Substance Use Treatment Episodes: Results from a National Representative Sample

Authors' Affiliations

Esther Adeniran, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN. Nathan Hale, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Manul Awasthi, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Adekunle Oke, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Shimin Zheng, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN.

Faculty Sponsor’s Department

Health Services Management & Policy

Additional Sponsors

Shimin Zheng

Classification of First Author

Graduate Student-Doctoral

Type

Oral Competitive

Project's Category

Health Services Delivery, Mental Health Services, Public Health

Abstract or Artist's Statement


Introduction: Drug dependence is a chronic medical illness that often requires multiple treatment episodes and the use of health services. However, patterns related to substance use and abuse treatment are not well known. Two critical factors that have not been explored in relation to the number of prior substance use treatment episodes (PSUTEs) are multiple age groups and waiting periods. Hence, the first aim of this study was to examine if the frequency of prior substance use treatment episodes varies by different age categories. The second aim was to assess the extent to which the waiting period prior to receipt of substance use treatment services influences the likelihood of experiencing multiple treatment episodes. Methods: Data used for this research was the 2018 Treatment Episodes Data Set— Admissions (TEDS-A) (N= 1,935,541), which comprised of admissions to alcohol or drug treatment facilities across the United States. Descriptive statistics of participants was conducted. Bivariate and Zero-Inflated Poisson regression (ZIPR) analyses were performed to evaluate the number of PSUTEs associated with age and days waiting to enter a treatment facility while adjusting for other potential confounders. Andersen's healthcare utilization model was used to categorize covariates into predisposing, enabling, needs, and environmental factors. P-value ≤ 0.01 was considered the criteria for rejection of all null hypotheses. Results: Among participants, the average frequency of PSUTE was 1.60. About 34.2% were 25-32 years old, while 19.2% had a waiting period of between 1 to 7 days. Bivariate analysis showed that the number of PSUTEs (0 to ≥ 5) was significantly associated with all age groups and waiting periods, respectively. The results for age showed that 1.4% (12-17 years old), 8.4% (18-24 years old), 14.7% (25-34 years old), 16.7% (35-49 years old), and 18.1% (≥ 50 years old) reported ≥ 5 PUSTEs. For individuals with a waiting period of ≥ 31 days, the number of PSUTEs included 36.5% (no PUSTE), 20.2% (1 PUSTE), 12.3% (2 PUSTEs), 6.8% (3 PUSTEs), 4.2% (4 PUSTEs), and 20.0% (≥ 5 PUSTEs). ZIPR analysis demonstrated that the predicted log count of PSUTE increased significantly for every increase in age category. While for every increase in the number of days waiting to enter treatment, the predicted log count of PSUTEs significantly decreased. All potential confounders including, gender, race, living arrangement, type of treatment or service setting at admission, primary substance used, presence of co-occurring mental & substance use disorder, health insurance, and census region, were significantly associated with the frequency of previous substance use treatment episodes (P-value ≤0.01). Conclusion: This study demonstrated that multiple age categories and wait periods are significant predictors of the number of previous substance use treatment episodes. Notably, younger participants showed fewer prior episodes than older participants. These factors should be considered in order to develop effective strategies to improve treatment use and access to substance use treatment facilities. Therefore, more research is needed to explore these factors as well as other unknown predictors influencing multiple substance use treatment episodes.

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Age and Days Waiting to Enter Treatment Facility are Significant Predictors of the Number of Previous Substance Use Treatment Episodes: Results from a National Representative Sample


Introduction: Drug dependence is a chronic medical illness that often requires multiple treatment episodes and the use of health services. However, patterns related to substance use and abuse treatment are not well known. Two critical factors that have not been explored in relation to the number of prior substance use treatment episodes (PSUTEs) are multiple age groups and waiting periods. Hence, the first aim of this study was to examine if the frequency of prior substance use treatment episodes varies by different age categories. The second aim was to assess the extent to which the waiting period prior to receipt of substance use treatment services influences the likelihood of experiencing multiple treatment episodes. Methods: Data used for this research was the 2018 Treatment Episodes Data Set— Admissions (TEDS-A) (N= 1,935,541), which comprised of admissions to alcohol or drug treatment facilities across the United States. Descriptive statistics of participants was conducted. Bivariate and Zero-Inflated Poisson regression (ZIPR) analyses were performed to evaluate the number of PSUTEs associated with age and days waiting to enter a treatment facility while adjusting for other potential confounders. Andersen's healthcare utilization model was used to categorize covariates into predisposing, enabling, needs, and environmental factors. P-value ≤ 0.01 was considered the criteria for rejection of all null hypotheses. Results: Among participants, the average frequency of PSUTE was 1.60. About 34.2% were 25-32 years old, while 19.2% had a waiting period of between 1 to 7 days. Bivariate analysis showed that the number of PSUTEs (0 to ≥ 5) was significantly associated with all age groups and waiting periods, respectively. The results for age showed that 1.4% (12-17 years old), 8.4% (18-24 years old), 14.7% (25-34 years old), 16.7% (35-49 years old), and 18.1% (≥ 50 years old) reported ≥ 5 PUSTEs. For individuals with a waiting period of ≥ 31 days, the number of PSUTEs included 36.5% (no PUSTE), 20.2% (1 PUSTE), 12.3% (2 PUSTEs), 6.8% (3 PUSTEs), 4.2% (4 PUSTEs), and 20.0% (≥ 5 PUSTEs). ZIPR analysis demonstrated that the predicted log count of PSUTE increased significantly for every increase in age category. While for every increase in the number of days waiting to enter treatment, the predicted log count of PSUTEs significantly decreased. All potential confounders including, gender, race, living arrangement, type of treatment or service setting at admission, primary substance used, presence of co-occurring mental & substance use disorder, health insurance, and census region, were significantly associated with the frequency of previous substance use treatment episodes (P-value ≤0.01). Conclusion: This study demonstrated that multiple age categories and wait periods are significant predictors of the number of previous substance use treatment episodes. Notably, younger participants showed fewer prior episodes than older participants. These factors should be considered in order to develop effective strategies to improve treatment use and access to substance use treatment facilities. Therefore, more research is needed to explore these factors as well as other unknown predictors influencing multiple substance use treatment episodes.

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