Mental Health and Peer Support Services Co-located in Substance Use Disorder Treatment Facilities in the United States

Substance use disorders (SUDs) often co-occur with other psychiatric disorders. Over 40% of individuals with SUD in a nationally-representative survey had co-occurring disorders (COD), that is, they met criteria for SUD as well another psychiatric disorder in the past year. The SUD treatment system should be ready to encounter and treat COD, as people with COD may be more likely to seek treatment. The purpose of this dissertation was to understand patterns and predictors of COD services provided in specialty SUD treatment facilities. In Chapter 1, we provided an overview of the problem, as well as a review of the data source and methodology used throughout the dissertation. In Chapter 2, we classified specialty SUD treatment facilities in the United States by the patterns of services provided using data from the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS). We used latent class analysis (LCA) to classify facilities based on mental health, peer support, clinical approaches, and primary focus of the facility in the 2012 N-SSATS. We found that a four-class solution differentiated classes of facilities by probability of providing mental health services and peer support beyond a single indicator of the facility’s primary focus. In Chapter 3, we used a three-step Vermunt-corrected latent class regression to cross-sectionally quantify the association between classes of SUD treatment facilities and facility-level predictors in 2012. We found that public ownership, hospital location or affiliation, and flexible financing and reimbursement structures were associated with being in a class with co-located mental health services. In Chapter 4, we used LCA to classify facilities in the 2006 and 2010 N-SSATS, and used latent transition analysis to quantify the probability of moving from one class to another over this five-year period. We found that 93% of facilities stayed in the same class over this time period. Of those that transitioned to another class, 66% added co-located mental health services. Finally, in Chapter 5 we provided an overview of findings and synthesis of results, discussed public health implications, and future directions for research