Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study

Dean Rivera,Hortensia Amaro,Donna Dueker

doi:10.1186/s13011-021-00357-y

Abstract

BackgroundCourt-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear.PurposeThis study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women.MethodsMultiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001).ConclusionsPolicy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout.Trial registrationClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648.

Highlights

Since 1980, the number of women incarcerated in U.S prisons and jails has increased by more than 750%, outpacing the increase in male incarceration by more than 50% [1, 2]
Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential substance use disorder (SUD) treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout
Study hypotheses Guided by prior empirical research, the primary purpose of this study is to examine differences in women’s residential SUD treatment retention by referral status (CJ, child protective services (CPS), and nonmandated)

Summary

Introduction

Since 1980, the number of women incarcerated in U.S prisons and jails has increased by more than 750%, outpacing the increase in male incarceration by more than 50% [1, 2]. Parental substance abuse is recognized in most states as a leading cause of child maltreatment and neglect [4, 5]. To address these complex societal problems, mandated residential substance use disorder (SUD) treatment, as an external motivator, has become a commonly used treatment engagement strategy in lieu of prosecution or loss of custodial rights by the criminal justice (CJ) and child protective services (CPS) systems, respectively [6, 7]. Whether child protective services (CPS)mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women

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