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 t o actually begin the program. We identified characteristics that predict tr eatment initiation. Design. In-person structured interviews were conducted with consecutive admissions to a large outpatient program (N = 1204), and t he health plan's automated registration data were used to determine treatme nt attendance. We compared those who returned to begin treatment with those who did not. Setting. The study was conducted at the Chemical Dependency p rogram of a large group model health maintenance organization (HMO). Partic ipants. Study subjects were individuals age 18 or over admitted to the prog ram. Measurement. Study variables included DSM-IV alcohol and drug dependen ce and abuse, Addiction Severity Index problem severity, motivation and tre atment entry measures. Findings. Those who were drug-dependent were less li kely to begin treatment than those dependent only on alcohol. Measures of m otivation, such as work-place pressures and the patient's perception of the importance of alcohol treatment, predicted starting treatment for individu als who were alcohol-dependent only or alcohol-and drug-dependent. Among pa tients who were dependent only on alcohol, women were more likely than men to start treatment, and for those who were drug-dependent, being employed a nd having higher drug severity scores predicted starting treatment. Conclus ions. Screening at intake may identify those at risk of not returning after admission to start treatment. Clinicians may consider making additional ef forts during the intake process to engage individuals who are unemployed an d have drug (as opposed to alcohol) disorders and less motivation.