Access to and Engagement in Substance Use Disorder Treatment Over Time
Open accessAbstract
OBJECTIVE: This study evaluated whether access to and engagement in substance use disorder treatment has improved from 2010 to 2016. METHODS: Data submitted by commercial and Medicaid health plans, representing over 163 million beneficiaries from 2010 to 2016, were analyzed. RESULTS: For commercial plans, identification increased (from 1.0% to 1.6%, p<0.001), the initiation rate declined (from 41.9% to 33.7%, p<0.001), and the engagement rate also declined (from 15.8% to 12.1%, p<0.001). The decline in the initiation and engagement rates could not be explained by the increasing identification rates. For Medicaid plans, the identification rate increased (from 3.3% to 6.7%, p<0.001), and the initiation and engagement rates were unchanged. CONCLUSIONS: Although an increasing proportion of health plan members are being identified with substance use disorders, the majority of these individuals are not engaging in treatment.
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Increases in identification of SUDs alone, without brief intervention and facilitated referral, have not been associated with commensurate increases in treatment connection.
“Administrative commercial and Medicaid healthcare data indicate that increases in identification of substance use disorders alone – in the absence of further brief intervention and facilitated referral - has not been associated with commensurate increases in these individuals’ connection with treatment (Liu et al., 2020).”
From Dental screening, counseling, and referral to treatment for substance use disorder: Survey of the National Dental Practice-Based Research Network (2026) · cites this paper as Liu et al., 2020
The Results and Conclusions report that identification of substance use disorders increased in commercial and Medicaid plans without corresponding improvement in treatment initiation and engagement. The paper does not establish that brief intervention or facilitated referral was absent, or assess whether their absence explains the lack of improvement. (LLM, conf=0.86)
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Research works printed but not linked: 8
- Garnick DW, Horgan CM, Acevedo A, et al: Criminal justice out- comes after engagement in outpatient substance abuse treatment. J Subst Abuse Treat 2014; 46:295-305
- Acevedo A, Miles J, Garnick DW, et al: Employment after be- ginning treatment for substance use disorders: the impact of race/ ethnicity and client community of residence. J Subst Abuse Treat 2018; 87:31-41
- Paddock SM, Hepner KA, Hudson T, et al: Association between process-based quality indicators and mortality for patients with substance use disorders. J Stud Alcohol Drugs 2017; 78:588-596
- Hepner KA, Paddock SM, Watkins KE, et al: Association between quality measures and perceptions of care among patients with sub- stance use disorders. Psychiatr Serv 2017; 68:1150-1156
- Watkins KE, Paddock SM, Hudson TJ, et al: Association between process measures and mortality in individuals with opioid use dis- orders. Drug Alcohol Depend 2017; 177:307-314
- Watkins KE, Paddock SM, Hudson TJ, et al: Association between quality measures and mortality in individuals with co-occurring mental health and substance use disorders. J Subst Abuse Treat 2016; 69:1-8
- Quinn AE, Reif S, Merrick EL, et al: How do private health plans manage specialty behavioral health treatment entry and continuing care? Psychiatr Serv 2017; 68:931-937
- Liang K-Y, Zeger SL: Longitudinal data analysis using generalized linear models. Biometrika 1986; 73:13-22
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McCauley, J. L., Crawford, P., Leo, M. C., McBurnie, M. A., Barton, D., Weidner, H. A., Rindal, D. B., & the National Dental PBRN Collaborative Group (2026) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.24-00383 · Cited by 1 · see citing works
- Authors
- Liu, J., Storfer-Isser, A., Mark, T. L., Oberlander, T., Horgan, C., Garnick, D. W., & Scholle, S. H.
- Affiliations
- RTI International (US)
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick).
- Venue
- Psychiatric Services
- Published
- 2020-07-01
- Volume
- 71
- Issue
- 7
- Pages
- 722-725
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W3008685616
- Cited by
- 16
- References
- 0
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 2 · 2020: 2
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- 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
- addiction treatment, treatment access, treatment engagement, treatment initiation, Medicaid, commercial health plans, health insurance beneficiaries
- MeSH terms
- Health Services Accessibility, Humans, Managed Care Programs, Medicaid, Patient Participation, United States, Substance-Related Disorders
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