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Access to and engagement in substance use disorder specialty treatment: Comparing justice-involved and other Veterans

Finlay AK, McGuire J, Rosenthal J, Blue-Howells J, Bowe T, Harris AH. Access to and engagement in substance use disorder specialty treatment: Comparing justice-involved and other Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.

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Research Objective: More than half of all Veterans involved in the criminal justice system have an alcohol or drug use disorder, and many have other mental health conditions, medical conditions, and employment and housing challenges. Veterans Health Administration (VHA) has programs dedicated to connecting justice-involved Veterans with VHA services to treat substance use disorder (SUD) and mental health symptoms and reduce their risk for criminal justice recidivism and homelessness, but the success of these programs in achieving these goals is unknown. We examined the effectiveness of VHA linkage programs on access to and engagement in VHA SUD treatment among justice-involved Veterans with SUD conditions compared to non-justice-involved Veterans with SUD conditions. Study Design: Using VHA health records, we selected all Veterans who received a SUD diagnosis in fiscal year 2012 (N = 501,593). Measures included justice-involved status, demographics (gender, age, race/ethnicity, urban/rural), type of SUD condition (alcohol or drug use disorder), presence of a co-occurring mental health (PTSD, personality disorders, depression, anxiety, schizophrenia, affective psychosis, other psychosis), and a random effect for VHA facility (N = 130). Outcome measures included access to SUD treatment, defined as receipt of any SUD services, and engagement in SUD treatment, defined as the number of SUD outpatient sessions, the number of SUD inpatient/residential stays, or any use of pharmacotherapy for alcohol or opioid dependence, used within one year of initial diagnosis. Multi-level model analyses were used to test whether justice-involved status predicted access to and engagement in SUD treatment. Population Studied: All Veterans seen at a VHA facility who received a SUD diagnosis in fiscal year 2012, compared by justice-involved (n = 28,608) or non-justice-involved (n = 472,985) status. Principal Findings: Justice-involved Veterans were more likely to access at least some SUD treatment compared to non-justice-involved Veterans (OR = 3.54, 95% CI: 3.44-3.64). Engagement in addiction-related outpatient treatment (b = 0.83, p < .001), defined as the number of sessions, and inpatient/residential stays (b = 0.63, p < .001), defined as the number of days, was greater for justice-involved Veterans. Among Veterans with alcohol dependence, utilization of pharmacotherapy was greater among justice-involved Veterans (OR = 1.39, 95% CI: 1.33-1.46). However, among Veterans with opioid dependence, utilization of pharmacotherapy was lower among justice-involved Veterans (OR = 0.82, 95% CI: 0.76-0.88). Conclusions: Despite the complex needs of this vulnerable population, VHA appears to be effectively connecting justice-involved Veterans with SUD treatment compared to other Veterans with SUD conditions. Increasing use of opioid pharmacotherapy may be especially important for Veterans being released from prison as they are at high risk for relapse and overdose. Implications for Policy, Delivery, or Practice: Determining the key aspects of the linkage programs and expanding them to other Veterans would help increase access to and engagement in VHA SUD treatment services.

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