title: Substance abuse detoxification and residential treatment among Medicaid-enrolled adults: rates and duration of subsequent treatment.
abstract: BACKGROUND
  Substance use disorders are chronic disorders with substantial public health significance, yet the treatment provided is often episodic despite ongoing need. Among the more severely ill individuals requiring detoxification or residential treatment, little empirical information is available about rates and predictors of subsequent engagement in necessary subsequent treatment.
  
  
  METHODS
  Using administrative data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state, we used multivariate regression to examine rates and predictors of subsequent treatment engagement and retention following new episodes of detoxification or residential substance abuse treatment among 5670 Medicaid-enrolled adults during 2004-2006.
  
  
  RESULTS
  Slightly less than half (49%) of the sample received follow-up care within 30 days of discharge. Rates of follow-up were significantly higher in individuals with a serious mental illness, and significantly lower in African-American individuals, males, individuals with disabilities, and those who received detoxification without residential treatment. The mean duration of follow-up treatment was 84 days, and was longer among individuals with a serious mental illness and Caucasians. Even after controlling for individuals' sociodemographic and clinical characteristics, there was substantial variation in follow-up rates among discharging providers.
  
  
  CONCLUSIONS
  The relatively low rates of follow-up care and relatively brief duration of treatment for many of those who received such follow-up care are concerning in a population receiving substance abuse detoxification or residential treatment. The markedly lower rates among those receiving detoxification alone without subsequent residential treatment and among those without a comorbid serious mental illness suggest that efforts specifically targeting those individuals may be of particular benefit.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 Ohara St., Pittsburgh, PA 15213, USA. steinbd@upmc.edu
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.forename: Jane N
authors.initials: JN
authors.lastname: Kogan
authors.forename: Mark
authors.initials: M
authors.lastname: Sorbero
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012114:Residential Treatment / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult