title: Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: a population-based approach.
abstract: BACKGROUND
  Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, 'acute only' (detoxification/stabilization), or 'ongoing' services.
  
  
  METHODS
  We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002-2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes.
  
  
  RESULTS
  Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15-49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained 'ongoing' treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive 'ongoing' treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received 'acute only' services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving 'ongoing' treatment.
  
  
  CONCLUSIONS
  Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. 'Ongoing' services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. Electronic address: jbernste@bu.edu.
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. Electronic address: taletha.derrington@sri.com.
authors.forename: Taletha M
authors.initials: TM
authors.lastname: Derrington
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. Electronic address: cbelanof@bu.edu.
authors.forename: Candice
authors.initials: C
authors.lastname: Belanoff
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. Electronic address: hjcab@bu.edu.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Cabral
authors.affiliation: Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: Hermik.Babkhanlou-Chase@state.ma.us.
authors.forename: Hermik
authors.initials: H
authors.lastname: Babakhanlou-Chase
authors.affiliation: Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: Hafsatou.Diop@state.ma.us.
authors.forename: Hafsatou
authors.initials: H
authors.lastname: Diop
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. Electronic address: deeny@bu.edu.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Evans
authors.affiliation: Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: Hilary.Jacobs@state.ma.us.
authors.forename: Hilary
authors.initials: H
authors.lastname: Jacobs
authors.affiliation: Center for Child and Adolescent Health Research and Policy, MassGeneral Hospital for Children, Boston, MA, USA. Electronic address: mkotelchuck@mgh.harvard.edu.
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
mesh_terms: D000293:Adolescent; D000328:Adult; D017831:Diagnosis, Dual (Psychiatry); D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008404:Massachusetts / Q000453:epidemiology; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D011153:Population; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Detoxification; Gender; Substance abuse treatment utilization; Substance use disorder; Women's health