ArticleThe International journal on drug policy2020
Stability in a large drug treatment system: Examining the role of program size and performance on service discontinuation.
Article in The International journal on drug policy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Private Equity Acquisition Of Substance Use Treatment Centers Increases Probability Of Public Health Insurance Acceptance.Health affairs (Project Hope) · 2025Article
- Sex, Race, and Ethnicity as Intersectional Predictors of Outpatient Substance Use Disorder Treatment Attrition.Substance abuse and rehabilitation · 2025Article
- Understanding the role of financial capacity in the delivery of opioid use disorder treatment.BMC health services research · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundLittle is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States.
methodsThis study relied on multi-year (2006-2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods.
resultsSixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services.
conclusionsProgram size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises.
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