title: Veterans' Service Utilization Patterns After Alcohol and Opioid Detoxification in VHA Care.
abstract: OBJECTIVE
  This study aimed to examine detoxification-related service utilization in the Veterans Health Administration (VHA).
  
  
  METHODS
  VHA data for 266,908 patients were used to examine rates and predictors of receiving detoxification, attending post-detoxification appointments, and entering specialty treatment. Multilevel, mixed-effects logistic regressions were used to examine associations between patient and facility characteristics and service utilization.
  
  
  RESULTS
  Nationally, 8.0% of VHA patients with alcohol or opiate dependence received detoxification in fiscal year 2013 (facility range=.1%-20.4%); 43.1% of detoxified patients received follow-up (11.1%-76.4%), and 49.9% entered specialty treatment (13.0%-77.2%). In adjusted analyses, detoxification was more likely among male, younger, white, and homeless patients with documented alcohol or opiate disorders and comorbid general medical conditions but without previous addiction treatment. Detoxification was also more likely in facilities with fewer vacant addiction therapist positions. Follow-up and specialty treatments were more likely among younger, healthier homeless patients with previous addiction treatment and a documented alcohol use disorder.
  
  
  CONCLUSIONS
  Detoxification-related service utilization was highly variable across the VHA. Interventions are needed to optimize use.
authors.affiliation: The authors are with Health Services Research and Development (HSR&D), U.S. Department of Veterans Affairs, Menlo Park, California (e-mail: christine.timko@va.gov ).
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.affiliation: The authors are with Health Services Research and Development (HSR&D), U.S. Department of Veterans Affairs, Menlo Park, California (e-mail: christine.timko@va.gov ).
authors.forename: Shalini
authors.initials: S
authors.lastname: Gupta
authors.affiliation: The authors are with Health Services Research and Development (HSR&D), U.S. Department of Veterans Affairs, Menlo Park, California (e-mail: christine.timko@va.gov ).
authors.forename: Nicole
authors.initials: N
authors.lastname: Schultz
authors.affiliation: The authors are with Health Services Research and Development (HSR&D), U.S. Department of Veterans Affairs, Menlo Park, California (e-mail: christine.timko@va.gov ).
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*