Gender Differences in Access to Publicly-Funded Substance Abuse Services

描述(申请人提供)：真正需要药物滥用服务的人很少。据估计，在美国，只有10%的药物滥用障碍患者曾经获得过针对他们的疾病的服务。在寻求药物滥用服务的人中，最常被提及的障碍之一是等待时间。实证研究证实了这一说法，表明等待超过一天会降低寻求服务的个人在服务可用时出现的可能性。尽管等待时间作为获取服务的一个组成部分至关重要，但没有任何研究试图记录--至少不是在州或国家一级--在公共资助的系统中，个人通常等待多长时间才能获得药物滥用服务。此外，目前尚不清楚等待时间是否存在性别差异。虽然至少有三项研究表明，在最初提出请求后，妇女可能比男子等待更长时间才能接受药物滥用服务，但这些研究在方法上存在重大缺陷，包括概括能力有限、抽样不具代表性，以及缺乏解决审查问题的措施。同样，人们对导致等待时间接受服务的因素知之甚少。为了解决这一差距，这项研究将确定药物滥用服务政策、资金和计划的组成部分，这些内容与男性和女性缩短治疗进入的等待时间有关。此外，它将确定最有可能经历漫长等待时间才能进入治疗的客户群体，因此可能特别容易受到治疗前退出的影响。这些知识可用于在政策和实践层面制定有针对性的干预措施，以减少等待时间。为此，这项研究将开发多水平比例风险模型，以实现以下具体目标：(1)检查评估的可能性如何作为性别等待时间的函数；(2)确定与性别评估的等待时间相关的客户和计划因素；(3)检查进入治疗的可能性作为性别等待时间的函数的变化；以及(4)确定与性别进入治疗的等待时间相关的客户和计划因素。为了进行这项研究，将使用伊利诺伊州酒精中毒和药物滥用分部(DASA)的数据。这项研究将包括DASA自动报告和跟踪系统(DARTS)2006-2008年的大约20万份治疗记录。DARTS包括唯一的客户端标识符，允许在整个系统中跟踪客户端的移动。虽然此数据集不是公开可用的，但使用它的权限已经得到保护。 与公共健康相关：尽管药物滥用造成了巨大的经济、社会和公共卫生成本，但只有只有10%的药物使用障碍患者曾接受过针对其病情的服务。最常提到的不接受治疗的原因之一是等待接受服务的时间。拟议的研究将确定政策和实践层面的具体因素，这些因素可以加以修改，以减少等待时间，从而提高公共系统药物滥用治疗的获得率。

DESCRIPTION (provided by applicant): Few individuals in need of substance abuse services actually receive them. Estimates suggest that in the United States, only 10% of individuals with substance abuse disorders ever obtain services for their condition. Among the most commonly cited barriers to access among seekers of substance abuse services is wait time. Empirical studies corroborate this claim, suggesting that waiting more than a single day decreases the likelihood that an individual seeking services will show up when they become available. Despite the critical importance of wait time as a component of access, no studies have attempted to document-at least not at the state or national level-how long individuals typically wait to receive substance abuse services in the publicly- funded system. Additionally, it is unknown whether there are gender differences in wait time. While at least three studies suggest that women may wait longer than men to receive substance abuse services after initial request, these studies suffer from significant methodological weaknesses, including limited generalizability, non-representative sampling, and the absence of measures to address censoring. Similarly, little is known about the factors that drive wait time to receive services. To address this gap, this study will identify components of substance abuse service policy, financing and programs that are associated with shorter wait time to treatment entry for men and women. Additionally, it will identify client populations that are most likely to experience long wait times to enter treatment and thus may be particularly vulnerable to pre-treatment dropout. Such knowledge can be used to inform the development of targeted interventions at the levels of policy and practice to reduce wait times. To this end, the study will develop multilevel proportional hazard models to pursue the following specific aims: (1) to examine how the likelihood of assessment changes as a function of wait time by gender; (2) to identify client and program factors associated with wait time to assessment by gender; (3) to examine how the likelihood of treatment entry changes as a function of wait time by gender; and (4) to identify client and program factors associated with wait time to treatment entry by gender. To conduct the study, data from the Illinois Division of Alcoholism and Substance Abuse (DASA) will be used. The study will include roughly 200,000 treatment records from 2006- 2008 from the DASA Automated Reporting and Tracking System (DARTS). DARTS includes unique client identifiers that allow for tracking clients' movements throughout the system. While this dataset is not publicly available, permission to use it has already been secured. PUBLIC HEALTH RELEVANCE: Despite the significant economic, social, and public health costs of substance abuse, as few as 10% of individuals with substance use disorders ever receive services for their condition. Among the most commonly-cited reasons for not entering treatment is wait time to receive services. The proposed study will identify specific factors at the levels of policy and practice that can be reworked to decrease wait times and consequently improve rates of substance abuse treatment access in the public system.