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Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program
Abstract
We studied gender differences in treatment process indicators among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but factors predicting these outcomes differed markedly. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married. Failure to initiate treatment was predicted in women by mental health diagnoses; in men, by less education. Treatment completion was predicted in women by higher income and legal/agency referral; in men, by older age. Failure to complete was predicted in women by more dependence diagnoses and higher Addiction Severity Index Employment scores; in men, by worse psychiatric status, receiving Medicaid, and motivation for entering treatment. More time spent in treatment was predicted, in women, by alcohol or opiate diagnoses and legal/agency referral; in men, by fewer mental health diagnoses, higher education, domestic violence victim status, and prior 12-step attendance. Clinical implications of results are discussed.
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“Prior research has found that women with more mental health problems are less likely to complete SUD treatment (Green et al., 2002)”
From Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults (2020) · cites this paper as Green et al., 2002
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Papamalis, F. E., Dritsas, I., & Knight, K. K. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1908358 · Cited by 10
“…severity and retention is inconclusive, with some studies reporting that higher psychiatric severity was positively associated with early drop out in substance misuse treatment (i.e. Castel et al., 2006; Siqueland et al., 2002) while other reported negative association (i.g. Green et al., 2002).”
ResultWhy Do Adolescents Drop Out of a Therapeutic Community for People With Drug Addiction?
Chen, G., Elisha, E., Timor, U., & Ronel, N. (2015) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2014.918002 · Cited by 10
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“, age,(3) race, sex,(3,7) employment(7)), addiction severity,(7) recent arrest,(8) and psychiatric comorbidity.(3,8) Additionally, the setting of care in which the individual is identified with an AOD use disorder (e.”
BackgroundSpécificités des problèmes d'utilisation de substances chez les femmes
Barrault, M. (2014) · Psychotropes · doi:10.3917/psyt.193.0009 · Cited by 15
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“However, studies show that the problems of female prisoners tend to be grave in nature, something that we were not able to measure comprehensibly here (Green et al., 2002; Viitanen et al., 2012).”
BackgroundMcNeese‐Smith, D. K., Wickman, M. E., Nyamathi, A., Kehoe, P., Earvolino-Ramirez, M., Robertson, S. M., McCann, M., & Obert, J. L. (2009) · Journal of Addictions Nursing · doi:10.3109/10884600903078969 · Cited by 11
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“This finding is consistent with mixed‐gender studies of treatment completion.[15] The poor knowledge of negative consequences due to drug use and reading skills among illiterate females may contribute toward treatment noncompletion.”
BackgroundResultPapamalis, F. E. (2020) · Substance Abuse Research and Treatment · doi:10.1177/1178221820951777 · Cited by 8
Oser, C. B., Biebel, E. P., Pullen, E. L., & Harp, K. L. H. (2011) · Journal of Social Service Research · doi:10.1080/01488376.2011.582020 · Cited by 9
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Smoking Cessation Outcomes among Individuals with Substance Use and/or Psychiatric Disorders
Khara, M., & Okoli, C. T. C. (2011) · Journal of Addiction Research & Therapy · doi:10.4172/2155-6105.1000115 · Cited by 9
“A previous study found sex-disaggregated differences in predictors of program completion among men and women in a Health Management Organization (HMO) -based substance abuse program [29].”
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Callahan, J. L., Heath, C., Aubuchon-Endsley, N. L., Collins, F. L., & Herbert, G. L. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21995 · Cited by 10
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“This is consistent with literature suggesting there are differential predictors for treatment retention across genders (Green et al., 2002).”
Interventions in individuals with specific needs
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“These are particularly important given the enhanced need to assist this young group with (1) disclosing their sexual minority identity, (2) issues of family rejection, (3) lack of housing and other stability factors (particularly those experiencing family rejection), and the (4) need for a safe environment given extre…”
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“Since women’s drug use is seen as more deviant, women may wait longer to seek help for their substance abuse problems, especially in high-threshold substance abuse treatment programmes [”
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Retention in Publicly Funded Methadone Maintenance Treatment in Two Western States
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“One found that Medicaid eligibility was negatively associated with treatment completion and hours of substance abuse treatment of men (but not women).(28) Another found that MCO Medicaid clients had similar or better outcomes than privately insured patients.”
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“Consistent with prior research (Amodeo et al., 2008; Brunette et al., 2004; Green et al., 2002; D. L. Haller et al., 2002; Lang & Belenko, 2000; Mertens & Weisner, 2000), a diagnosis of a co-occurring disorder was found to be a predictor of dropout.”
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“This study cannot discern the reasons for this finding, thoughonemayspeculate that it reflects the challenge of treatment retention among populations with co-occurring mental illness (24,25).”
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Bachman, S. S., Walter, A. W., Kuilan, N., & Lundgren, L. M. (2007) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2007.05.012 · Cited by 5
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“Public insurance typically covers shorter stays in substance use treatment compared to private insurance, and is associated with being a precursor for treatment drop-out (Green et al. 2002).”
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“The extant literature suggests that the most critical individual risk factors for treatment engagement of urban women with OUD include five categories: poor physical health; poor mental health (Green et al., 2002; Greenfield et al., 2007); criminal justice involvement (Brady & Ashley, 2005; Messina et al.”
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“In general, variables predicting better treatment outcome include higher socioeconomic [4,5] and job status [6,7], whereas poorer treatment outcome is predicted by variables such as comorbid psychiatric disorders [8,9], history of sexual or physical abuse [10,11], and having a substance-using partner [12].”
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“…ef fi cacy of addiction treatments due to factors such as institutional bias, legal constraints, discrimination and individual treat-ment adherence (Bensley et al., 2017; Green et al., 2002; Kelly et al., 2005; Lê Cook & Alegría, 2011; Lo & Cheng, 2011; Mennis & Stahler, 2016; Scarpa et al., 2023).”
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An Examination of Individual and Group Outcomes of Male and Female Community Treatment Clients
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“…demonstrated that an eclectic approach to treatment beginning with matching clients’ needs is an effective approach in addiction counseling (Taxman & Bouffard 2003); however, differences by sex appear to have some effect upon the length of time individuals remain in treatment (Green et al. 2002).”
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BackgroundMethodSelf-citationCorrelates of Treatment Readiness Among Formerly Incarcerated Homeless Women
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“While gender differences are well examined concerning substance-related epidemiology, demographic, the progression of dependence, comorbidity, treatment entry, retention, and completion [48-50], there aren ́t many studies, which investigated the differential effects on symptom load between men and women.”
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Roys, M. R. (2021) · Louisiana State University · doi:10.31390/gradschool_dissertations.5601
Rose, N. D. (2015) · Policy Press eBooks · doi:10.51952/9781847426734.bm002
The Impact of Traumatic Brain Injury on the Receipt of Services Following Release from Prison
Veeh, C. A., Lattimore, P. K., Stainbrook, K. A., Aldridge, A., & Pettus‐Davis, C. (2023) · IntechOpen eBooks · doi:10.5772/intechopen.109467
Rose, N. D. (2015) · Policy Press eBooks · doi:10.56687/9781447354727-013
Kwofie, F. A. A., Frimpong, D. O., & Baffoe, R. P. (2023) · European Journal of Human Resource Management Studies · doi:10.46827/ejhrms.v6i2.1462
“Kidder (2002) supported by Green et al. (2002) argued that men and women may also have different cognitive abilities.”
BackgroundKirsch, D. E., Belnap, M. A., Kady, A., & Ray, L. A. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45863-7.00096-2
Lucas, M. M., Ngo, Q., & Yang, C. C. (2026) · IEEE International Conference on Healthcare Informatics (ICHI) · doi:10.1109/ichi69079.2026.00016
Metadata
- Authors
- Green, C. A., Polen, M. R., Dickinson, D. M., Lynch, F. L., & Bennett, M. D.
- Affiliations
- Oregon Health & Science University (US)
- Kaiser Permanente Center for Health Research (US)
- Kaiser Permanente (US)
- Corresponding author
- Green, Carla A
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2002-12
- Volume
- 23
- Issue
- 4
- Pages
- 285-295
- ISSN
- 0740-5472 (ISSN-L)
- OpenAlex
- W2122782976
- Cited by
- 201
- References
- 58
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 6 · 2022: 1 · 2021: 3 · 2020: 10 · 2019: 6 · 2018: 12 · 2017: 11 · 2016: 11 · 2015: 19 · 2014: 13 · 2013: 16 · 2012: 5
- FWCI
- 4.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Substance Abuse Treatment (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- National Institutes of Health (5r01aa010849-04)
- National Institute on Alcohol Abuse and Alcoholism (AA10849)
- 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 › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- gender differences, addiction treatment, treatment initiation, treatment completion, treatment retention, health maintenance organizations, predictors of treatment outcome, alcoholism, opioid use disorder, mental health diagnoses, domestic violence, 12-step programs, Medicaid, employment, income
- MeSH terms
- Adult, Female, Gender Identity, Health Maintenance Organizations, Humans, Male, Patient Acceptance of Health Care, Patient Compliance, Patient Dropouts, Retention, Psychology, Sex Factors, United States, Substance Abuse Treatment Centers, Substance-Related Disorders
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