Evaluating  the Quality of Addiction Treatment Across the United States

This week we will be discussing an article written by authors Mark, Dowd, and Council published on August 20, 2020 in the RTI International Journal. In this article titled, “Tracking Quality of Addiction Treatment Over Time and Across states: Using the Federal Government’s “Signs” of Higher Quality”, the authors track trends in the signs of higher-quality addiction treatment as defined by the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Addiction (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Why did they do it?

Substance abuse and addiction disorders are a major concern in the United States. Unfortunately, individuals with substance use disorders often report challenges finding high-quality treatment, with SAMHSA’s National Survey on Drug Use and Health reporting that one in five adults who felt a need for addiction treatment, but did not receive treatment, reported the reason was because they did not know where to access intervention. As the authors explain, government groups (e.g., NIDA, NIAAA, SAMHSA) have compiled decades of research to identify principles or “signs” of higher quality addiction treatment programs. 

Thus, the goals of this study were to determine the percentage of specialty addiction treatment facilities that possess high quality attributes, investigate whether the percentage of facilities offering higher quality care has increased over time, and to reveal how these proportions vary by state.

How did they do it?

First, the authors compiled the characteristics of high-quality treatment programs identified by NIDA, NIAAA, and SAMHSA . Data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for 2007-2017 were used for this study. The N-SSATS is an annual survey of all addiction facilities (i.e., public and private facilities, residential, outpatient, opioid treatment programs, and detoxification programs) in the United States, conducted by SAMHSA. The survey assesses   facility characteristics, service modalities, services provided, and types of clients served. 

The N-SSATS survey data captured five of the eight high-quality treatment characteristics. The authors used this data to calculate national averages for each measure, as well as percent of change over 2007, 2011, and 2017. 

What did they find?

Broadly speaking, the authors identified that a greater percentage of facilities had attributes indicating higher-quality in 2017 compared to 2007, with most of these improvements occurring between 2011 and 2017. However, even in 2017, fewer than 50% of facilities offered medications for opioid treatment, testing for Hepatitis C, HIV, and STD’s, self-help groups, employment assistance, and transportation assistance. It is worth noting that in 2007, only 26% of facilities provided medication for opioid treatment, so a jump to approximately 40% in 2017 is a notable increase. 

In terms of treatment modality, in 2017 more than 90% of facilities reported using Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI). Additionally, approximately 52% of facilities reported that they assess their patients for mental health comorbidities, and 68%  reported providing mental health services in general. The most commonly offered recovery support service was family counseling (83%), followed by peer support (57%), housing assistance (54%), self-help groups (46%), transportation assistance (44%), and employment assistance (39%). 

State-by-state, there is much variability in the percent of facilities that offer high quality services. The authors provide several fantastic visualizations that represent these data, and we encourage you to visit their paper to check them out!

What does it all mean (our take)?

While there is certainly still room to grow, the quality of substance abuse/addiction treatment facilities appears to be improving over time. This promising finding suggests that as we learn more about the incredibly complex nature of substance abuse, we are slowly (but surely) applying this knowledge to our treatment approaches.

Nevertheless, there is still room for improvement and growth. We feel that continuously learning from the data about what works best for specific patients will ultimately lead us to the most successful, high quality treatment of substance abuse across our country.