Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers

Abstract

Although successful transitions from detoxification to substance use disorder treatment are associated with improved outcomes, many detoxification patients do not initiate treatment. This qualitative study informs detoxification and addiction treatment providers, and health systems, about how to improve detoxification to treatment transitions, by reporting detoxification providers' views of transition facilitators and barriers. The sample consisted of 30 providers from 30 Veterans Health Administration detoxification programs. Themes regarding transition facilitators and barriers emerged at the patient, program (detoxification programs, and addiction programs), and system levels. Detoxification program-level practices of discharge planning, patient education, and rapport building were reported as facilitating the transition to treatment. Six themes captured transition facilitators within addiction treatment programs: the provision of evidence-based practices, patient-centered care, care coordination, aftercare, convenience, and a well-trained and professional staff. This study expands previous literature on detoxification and addiction treatment by systematically and qualitatively examining factors that promote and hinder treatment initiation after inpatient and outpatient detoxification, from a provider perspective, in an era of health care reform and expanded substance use disorder treatment.

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

“…Access to treatment for substance use disorders is a significant issue in non metropolitan areas as travel distances may pose a barrier . We focused on the impact of travel time on continuity after discharge from detoxification or residential treatment for substance use disorders because continuity is associated with better outcomes, but rates are relatively low . In our study, travel times to the original agency providing treatment are sometimes, but not always, significant in predicting continuity within 14 days.…”

“…Even if a potential option for continuity is located close to clients’ residences, there is no assurance that there is availability for treatment at that location, or other locations within a short travel time, or if the services are a good match for the client's needs. When a client is placed on a waiting list, keeping them engaged with the treatment system by providing them with some services as they wait is good practice . In this study, we counted the location of options for continuity, but we could not evaluate the accessibility of that treatment in terms of provision of flexible hours for treatment, greater staffing, or provision of transportation.…”

“…When a client is placed on a waiting list, keeping them engaged with the treatment system by providing them with some services as they wait is good practice . In this study, we counted the location of options for continuity, but we could not evaluate the accessibility of that treatment in terms of provision of flexible hours for treatment, greater staffing, or provision of transportation. Another study demonstrated that increased distance to care did not decrease utilization of the behavioral health treatment services when transportation was provided to the client when needed …”

“…Second, a focus on care coordination among agencies could foster completed referrals, although this may be difficult when trying to coordinate with agencies that may be located hours from each other. Coordination activities could include keeping the client engaged with the treatment system if they are put on a waiting list for the next level of care, or assigning staff to call patients who completed detoxification with reminders about treatment appointments …”

“…Using the Andersen/Davidson model of service utilization, which theorizes that both individual and contextual factors impact service use, we selected covariates at both the client and agency level that might facilitate or hinder accessing services after discharge. Our choice of covariates also was based on prior research on continuity . For residential treatment analyses, we controlled for client's age, gender, race/ethnicity, education, marital status, employment status, past month use of substances (alcohol, marijuana, cocaine, opioids, methamphetamines, and other drugs), age at first use of any substance, and homelessness.…”