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Cited by 50Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentMental Health Treatment and Access

Patient predictors of substance use disorder treatment initiation in primary care

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Ober, Allison J., Watkins, Katherine E., McCullough, Colleen M., Setodji, Claude M., Osilla, Karen, Hunter, Sarah B.·2018·Journal of Substance Abuse Treatment
DOI 10.1016/j.jsat.2018.04.004PMC PMC6336395
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Abstract

Introduction Primary care clinics are opportune settings in which to deliver substance use disorder (SUD) treatment, but little is known about which patients initiate treatment in these settings.Methods Using secondary data from a RCT that aimed to integrate SUD treatment into a federally qualified health center (FQHC) using an organizational readiness and collaborative care (CC) intervention, we examined patient-level predictors of initiation of evidence-based practices for opioid and/or alcohol use disorders (OAUDs): a brief behavioral treatment (BT) based on motivational interviewing and cognitive behavioral therapy and medication-assisted treatment (MAT) (extended-release injectable naltrexone (XR-NTX) for patients with an alcohol use disorder or opioid use disorder and buprenorphine/naloxone (BUP/NX) for patients with an opioid use disorder). Using the Andersen model of health care access, we tested bivariate and multivariate logistic regression models to assess associations between patient factors and initiation of BT and MAT.Results Twenty-three percent of all participants (N = 392) received BT and 13% received MAT. In the multivariate model examining factors associated with initiation of BT, being of "other" or "multiple" races compared with being White (OR = 0.45, CI = 0.22, 0.92), being homeless (OR = 0.45, CI = 0.21, 0.97) and having been arrested within 90 days of baseline (OR = 0.21 CI = 0.63, 0.69) were associated with significantly lower odds of initiating BT. Greater self-stigma (OR = 1.60, CI = 1.06, 2.42), receiving MAT (OR = 5.52, CI = 2.34, 12.98), and having received the CC study intervention (OR = 12.95, CI = 5.91, 28.37) were associated with higher odds of initiating BT. In the multivariate model examining patient factors associated with initiating MAT, older age (OR = 1.07, CI = 1.03, 1.11), female gender (OR = 3.05, CI = 1.25, 7.46), having a diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence compared with have a diagnosis of alcohol dependence only (OR = 3.03, CI = 1.17, 7.86), and having received at least one session of BT (OR = 6.42, CI = 2.59, 15.94), were associated with higher odds of initiating MAT.Conclusions Individuals who initiate BT for OAUDs in a FQHC are less likely to be homeless and more likely to have greater self-stigma. Those who receive MAT are more likely to be of older age, female, and to have a diagnosis of heroin abuse or dependence, with or without concomitant alcohol abuse or dependence, rather than alcohol abuse or dependence alone. Receiving collaborative care (e.g., a warm handoff, and follow-up by a care coordinator) may be critical to initiating BT. Receiving at least one session of BT is associated with higher odds of receiving MAT, and receiving MAT is associated with higher odds of receiving BT. The Andersen model of health care access provides some insight into who initiates BT and MAT for OAUD treatment in FQHC-based primary care; further research is needed to explore system-level factors that may also influence treatment initiation.

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  • Need factors tend to be the strongest predictor of physical and behavioral health service use.

    “Need factors refer to perceived/evaluated physical and/or behavioral health problem severity and tend to be the strongest predictor of physical [30] and behavioral health service use [31,32].”

    From Treatment Use Among U.S. Adults with a Substance Use Disorder: Associations with Symptom Severity, Problem Self-Perception, Comorbid Mental Illness, and Mental Health Treatment (2025) · cites this paper as [32]

    The Introduction and Methods identify need or severity factors as predictors of access and substance-use treatment initiation. But the Results (sections 3.2–3.3; page unavailable) do not establish them as the strongest predictors of behavioral health service use: the multivariate models also identify substantial associations for enabling factors, including receipt of MAT or brief treatment. This paper does not assess physical health service use, which the citing sentence assigns to a different citation. (LLM, conf=0.86)

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Research works printed but not linked: 4

  1. Andersen RM 1995 Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior 36 1 1 10 7738325
  2. Hines AL Barrett ML Jiang HJ Steiner CA 2014 Conditions with the largest number of adult hospital readmissions by payer, 2011 HCUP statistical brief # 172 Retrieved from Rockville, MD: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf 24901179
  3. Park-Lee E Lipari RN Hedden SL Copello AP Kroutil LA 2015 Receipt of Services for Substance Use and Mental Health Issues among Adults: Results from the 2015 National Survey on Drug Use and Health Retrieved from Rockville, MD: https://www.samhsa.gov/data/sites/default/files/NSDUH-ServiceUseAdult-2015/NSDUH-ServiceUseAdult-2015/NSDUH-ServiceUseAdult-2015.htm 29431966
  4. U.S. Department of Health and Human Services (HHS) Office of the Surgeon General 2016 Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health Washington DC HHS 28252892

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Authors
Ober, A. J., Watkins, K. E., McCullough, C. M., Setodji, C. M., Osilla, K., & Hunter, S. B.
Affiliations
RAND Corporation (US)
Corresponding author
  • Ober, Allison J.
  • Watkins, Katherine E.
  • McCullough, Colleen M.
  • Setodji, Claude M.
  • Osilla, Karen
  • Hunter, Sarah B.
ORCID
Venue
Journal of Substance Abuse Treatment
Publisher
Elsevier BV
Published
2018-07
Volume
90
Pages
64-72
ISSN
0740-5472 (ISSN-L)
DOI
10.1016/j.jsat.2018.04.004
PMC
PMC6336395
OpenAlex
W2802721624
Cited by
50
References
65
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 2
FWCI
3.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Substance Abuse Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (NIDA) (R01DA034266)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
primary care, opioid use disorder, alcoholism, medication-assisted treatment, collaborative care, buprenorphine/naloxone, self-stigma, homelessness, arrest history, racial disparities, Andersen Behavioral Model, federally qualified health centers, barriers to treatment, patient predictors, heroin addiction
MeSH terms
Buprenorphine, Naloxone Drug Combination, Adult, Age Factors, Alcoholism, Cooperative Behavior, Female, Health Services Accessibility, Humans, Male, Middle Aged, Naltrexone, Opioid-Related Disorders, Primary Health Care, Psychotherapy, Brief, Sex Factors, Cognitive Behavioral Therapy, Multivariate Analysis, Logistic Models, Motivational Interviewing

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