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Background: The increasing relevance of substance use disorder (SUD) within the Asian American, Native Hawaiian, and Pacific Islander (AA&NH/PI) communities, particularly amidst rising anti-Asian hate incidents and the disproportionate health and economic challenges faced by the NH/PI community during the COVID-19 pandemic, underscores the urgency of understanding substance use patterns, treatment disparities, and outcomes., Methods: Following PRISMA guidelines, 37 out of 231 studies met the search criteria. Study characteristics, study datasets, substance use rates, SUD rates, treatment disparities, treatment quality, completion rates, and analyses disaggregated by the most specific AA&NH/PI ethnic group reported were examined., Results: Despite increased treatment admissions over the past two decades, AA&NH/PI remain underrepresented in treatment facilities and underutilize SUD care services. Treatment quality and completion rates are also lower among AA&NH/PI. Analyses that did not disaggregate AA and NHPI as distinct groups from each other or that presented aggregate data only within AA or NHPI as a whole were common, but available disaggregated analyses reveal variations in substance use and treatment disparities among ethnic groups. There is also a lack of research in exploring within-group disparities, including specific case of older adults and substance use., Conclusion: To address disparities in access to substance use treatment and improve outcomes for AA&NH/PI populations, targeted interventions and strategic data collection methods that capture diverse ethnic groups and languages are crucial. Acknowledging data bias and expanding data collection to encompass multiple languages are essential for fostering a more inclusive approach to addressing SUD among AA&NH/PI populations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: New York State implemented a Health Homes (HH) care management program to facilitate access to health services for Medicaid enrollees with multiple chronic conditions. This study assessed the impact of HH on health care utilization outcomes among enrollees who have substance use disorder (SUD)., Methods: Using HH enrollment data and Medicaid claims data 1 year before and after enrollment, this study compared HH enrollees who enrolled between 2012 and 2014 to a statistically matched comparison group created with propensity score methods. Analyses used generalized gamma models, logistic regression models, and difference-in-differences analyses to assess the impact of HH on general (all-cause) health care and SUD-related outpatient, emergency department (ED), hospitalization, and detoxification utilization as well as total Medicaid cost., Results: The sample consisted of 41,229 HH enrollees and a comparison group of 39,471 matched patients. HH-enrolled patients who had SUD utilized less SUD-related ED services (average marginal effect (AME) = -1.85; 95% CI = -2.45, -1.24), SUD-related hospitalizations (AME = -1.28; 95% CI: -1.64, -0.93), and detoxification services (AME = -1.30; 95% CI = -1.64, -0.96), relative to the comparison group during the 1 year post-HH enrollment. SUD-related outpatient visits did not change significantly (AME = -0.28; 95% CI = -0.76, 0.19) for enrollees, but general health care outpatient visits increased (AME = 1.63; 95% CI = 1.33, 1.93)., Conclusion: These findings provide preliminary evidence that care management programs can decrease ED visits and hospitalizations among people with SUD., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The New York State (NYS) Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) was launched in 2015 to determine the most appropriate level of care for individuals seeking addiction treatment. However, research has not studied its predictive validity. We examined the predictive validity of the LOCADTR recommendation for outpatient treatment by determining whether those who entered a level of care (LOC) concordant with the LOCADTR recommendation differed in continuous engagement in treatment compared to those who entered a discordant LOC., Methods: The study combined data from two NYS administrative sources, the LOCADTR database and a treatment registry. The study examined characteristics of the clients who entered concordant and discordant LOCs as well as tested for differences in continuous engagement of clients who entered discordant care compared to a propensity score-matched comparison group of clients who entered the concordant LOC., Results: Among clients for whom the LOCADTR recommended the outpatient LOC, concordant clients who entered the outpatient LOC were more likely to be retained in care than discordant clients who entered the inpatient LOC (aOR = 0.53; 95% CI = 0.36, 0.77). We did not observe statistical differences in continuous engagement among clients who were recommended for outpatient and entered that LOC versus those who entered the outpatient rehabilitation LOC instead (aOR = 1.08; 95% CI = 0.90, 1.30)., Conclusion: This study provides support for predictive validity of recommendations stemming from the LOCADTR. Clients, treatment providers, and payers benefited from a tool that provides clear guidance and predictively valid recommendations for treatment placement. The study found that clients were more likely to be retained in treatment for 6 months or longer if admitted to outpatient care, as recommended by the LOCADTR algorithm, rather than to inpatient treatment. One factor accounting for the longer engagement in outpatient care is the low level of continuity of care among patients being discharged from inpatient treatment., (Copyright © 2021. Published by Elsevier Inc.)

New instruments are needed to assist substance use disorder (SUD) clinics in monitoring client treatment progress. This paper describes the development of an 8-item monitoring tool and results from a pilot to understand the tool's structure and reliability. 393 clients completed the tool upon treatment entry. A factor analysis resulted in a 2-factor solution: SUD symptoms and treatment progress. Multiple regression analyses showed that clients in inpatient detoxification had lower scores than those in less intensive levels of care. Acceptable internal consistency reliability was found. This study shows promise for the tool and sets the stage for future validation work.

Two studies examined inter-rater reliability and content-related validity of an addiction treatment level of care determination tool currently in use in New York, the LOCADTR 3.0. The studies occurred after tool implementation. In study 1, 139 providers used the LOCADTR 3.0 to determine level of care for four case vignettes. Inter-rater reliability coefficients were calculated. In study 2, 387,338 state records from existing data were analyzed to determine how often providers opted to override the LOCADTR 3.0 level of care determination by choosing an alternative level of care. In study 1, an acceptable inter-rater reliability (IRR = .57-.59) was found. Good indication of content-related validity was also found; participants chose the same level of care the study team chose for each vignette 80% of the time. In study 2, the override option was selected only 10% of the time, further establishing the content validity of the tool. These studies provide evidence for acceptable preliminary reliability and validity of the LOCADTR 3.0.

Rationale, Aims, and Objectives: There are well-documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency., Methods: Patients presenting to an emergency or primary care setting were screened for risky substance use (n = 41 567). Patients with a positive screen were further assessed for psychosocial, health, and substance use problems (n = 1604). Differences in patient characteristics between primary care and emergency settings were examined using chi-square and t tests. Multilevel logistic regression was used to examine whether setting type predicted screening results. Site-level indicators of implementation success were calculated (percentage prescreens completed, percentage full screens completed, and percentage refused services) for all patient visits (n = 78 656)., Results: As compared with primary care patients, emergency patients had more severe substance use patterns and screening scores, were more likely to use a variety of illicit drugs, and reported more psychosocial issues. In logistic regression models, setting type did not predict whether patients screened positive; however, it did predict screening into a higher vs lower risk category such that emergency patients were more likely to be in a higher risk category. Emergency settings had lower indicators of implementation success (eg, 14% lower prescreen completion rate) as compared with primary care settings on some implementation measures., Conclusions: This evaluation found important differences in patient characteristics and screening and implementation results between primary care and emergency settings. Health care organizations and administrators implementing screening and brief intervention should attend to setting differences that could affect implementation and clinical care., (© 2018 John Wiley & Sons, Ltd.)

Reducing repeat use of costly inpatient services, such as inpatient withdrawal management, among Medicaid members is a target of healthcare reform. However, characteristics of frequent users of inpatient withdrawal management are understudied. We described the characteristics, service utilization, and costs of New York Medicaid clients who use withdrawal management services by analyzing data from Medicaid records from 2008. We examined follow-up care for individuals with different levels of repeat withdrawal management. We found 32,196 Medicaid withdrawal management patients with a total of 67,073 episodes and we divided patients into low (1 episode, n = 19,602), medium (2-3 episodes, n = 8619) and high (≥4 episodes, n = 3978) use categories. High users had almost 8 times the withdrawal management cost of low users. Similarly, they had 5 times more emergency department visits than low users. High users had high levels of homelessness (75%), 20% had HIV/AIDS, and 40% had Hepatitis. High withdrawal management users were less likely than low users to receive any follow-up treatment services. Medicaid clients with high utilization of inpatient withdrawal management are a small but costly population with poor follow-up rates to subsequent treatment services. They are a socially disenfranchised group that may benefit from targeted services to address their complex clinical needs., (Copyright © 2018 Elsevier Inc. All rights reserved.)

High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n=41,054); high-cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Intensive case management (ICM) is effective for facilitating entry into and retention in outpatient substance use disorder treatment (OSUDT) for low-income substance-dependent women; however, no studies have specifically examined the moderating impact of depressive symptoms on ICM. The purpose of this study was to investigate whether depressive symptoms moderated ICM's effect on OSUDT engagement, attendance, and outcomes for substance-dependent women on Temporary Assistance for Needy Families (TANF). It was hypothesized that highly depressed women would demonstrate worse outcomes on all indicators., Method: Logistic regression and generalized estimating equations were used to determine depression's moderating impact on ICM in a secondary analysis of data from a randomized controlled trial comparing the effectiveness of ICM to usual care provided by local public assistance offices in Essex County, NJ. Substance-dependent women (N = 294) were recruited while being screened for TANF eligibility and were followed for 24 months., Results: Findings revealed that high levels of depressive symptoms moderated the effectiveness of ICM in unexpected directions for two outcome variables. Subjects with high levels of depressive symptoms in ICM were (a) significantly more likely to engage in at least one treatment program than those in usual care and (b) associated with the fewest mean drinks per drinking day across the 24-month follow-up period. Independent effects for high levels of depressive symptoms and ICM were also found to positively influence engagement, attendance, and percentage days abstinent., Conclusions: ICM is effective for substance-dependent women with a broad spectrum of depressive symptoms in enhancing OSUDT utilization and outcomes.

Research with the Important People instrument has shown that social support for abstinence is related to alcohol treatment outcomes, but less work has been done on the role of network support in drug treatment outcomes. A drug and alcohol version of the Important People instrument (IPDA) was developed and administered to 141 patients in residential treatment for cocaine dependence. Three components were found, all with acceptable internal consistency: (a) substance involvement of the network, (b) general/treatment support, and (c) support for abstinence. These components and three fundamental network characteristics (size of daily network, size of network, and importance of the most important people) were investigated as correlates of pretreatment and posttreatment alcohol and drug use. The general/treatment support component and network size were inversely related to pretreatment days using drugs, whereas network substance involvement positively correlated with pretreatment drinking frequency. Size of the daily network predicted less drinking, less drug use, and less problem severity during the 6 months after treatment, whereas general/treatment support and support for abstinence did not predict outcome. Network substance involvement decreased for patients who stayed abstinent but not for those who later relapsed. Results suggest that increasing the number of people the patient sees daily while replacing substance-involved with abstinent-supportive people may improve treatment outcomes. Treatment programs may use the IPDA to identify clients most likely to benefit from changes in their social networks.

Objective: We examined abstinence rates among substance-dependent women receiving Temporary Assistance for Needy Families (TANF) in intensive case management (ICM) over 24 months and whether ICM yielded significantly better employment outcomes compared with a screen-and-refer program (i.e., usual care)., Methods: Substance-dependent (n = 302) and non-substance dependent (n = 150) TANF applicants in Essex County, New Jersey, were recruited. We randomly assigned substance-dependent women to ICM or usual care. We interviewed all women at 3, 9, 15, and 24 months., Results: Abstinence rates were higher for the ICM group than for the usual care group through 24 months of follow-up (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.36, 3.29). A statistically significant interaction between time and group on number of days employed indicated that the rate of improvement over time in employment was greater for the ICM group than for the usual care group (incidence rate ratio = 1.03; 95% CI = 1.02, 1.04). Additionally, there were greater odds of being employed full time for those in the ICM group (OR = 1.68; 95% CI = 1.12, 2.51)., Conclusions: ICM is a promising intervention for managing substance dependence among women receiving TANF and for improving employment rates among this vulnerable population.

Objective: Prior research on health care utilization after treatment for substance misuse disorders has not accounted for posttreatment clinical outcomes as well as putative confounds associated with both substance use and health care. This study examined the association of posttreatment health care utilization with treatment factors (program type and time in treatment) and baseline psychological/behavioral risk factors (smoking status and level of depressive, alcohol and drug dependence symptoms). The study also examined whether posttreatment clinical outcomes-participation in aftercare, Alcoholic Anonymous (AA) attendance, substance use, depressive symptoms and smoking- were associated with subsequent health care utilization., Method: We analyzed predictors of posttreatment medical hospitalizations and emergency department (ED) use among 15,041 participants in a multistate treatment evaluation project conducted from 1987 to 1995., Results: Greater time in treatment reduced the likelihood of future hospitalizations and ED use, whereas clients in outpatient treatment were less likely to be hospitalized. Baseline measures of depressive, alcohol and drug dependence symptoms were each independently associated with subsequent health care use. Posttreatment aftercare participation reduced the likelihood of future hospitalization and ED use, whereas AA attendance also reduced the likelihood of hospitalization. In addition, posttreatment counts of depressive symptoms increased the likelihood of future hospitalization and ED use. Substance relapse increased the likelihood of subsequent ED use., Conclusions: The study supports the public health importance of substance misuse disorders treatment, with greater treatment involvement associated with lower high-cost medical utilization. Treatment clinical outcomes-posttreatment relapse and depressive symptoms-partially mediate the effect of treatment on health care utilization.

Aims: We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. Methods: We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. Results: CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = −1518, −391) and reduced days of detox utilization by about 1.0 days (95% CI = −1.9, −0.1) among HFS. Conclusion: Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients. [ABSTRACT FROM AUTHOR]