Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations.
OBJECTIVE
This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment.


METHODS
Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients.


RESULTS
In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR, .65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3).


CONCLUSIONS
Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs.
Friedmann
Peter D
PD
Division of General Internal Medicine, Rhode Island Hospital, Providence 02903, USA.
Lemon
Stephenie C
SC
Stein
Michael D
MD
D'Aunno
Thomas A
TA
D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008329:Managed Care Programs / Q000706:statistics & numerical data; D017057:Medically Uninsured; D011203:Poverty; D016079:Refusal to Treat; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D017664:Uncompensated Care; D014481:United States; D014850:Waiting Lists