Substance Abuse Treatment Outcomes and System Improvements

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					Bureau of Substance Abuse Services

    Admissions and Outcomes

    Massachusetts Department of Public Health
      Bureau of Substance Abuse Services

       Health and Addictions Research, Inc.

                    July, 2000
                                      
     Today’s Presentation             
                                      
                               Introduction

• Who is being admitted to publicly
  funded substance abuse treatment?


• What are outcomes of publicly
  funded substance abuse treatment?
                                        Total Admissions
                                                FY ‘88 to FY ’99
                       Thousands
          140
                                                                                                                                     118
          120                                                                                104                 108
                                   100                                    91
          100                                         90                                                                    116
                                                                                                         103
            80         102                 94                                        98
                                                               86
            60
            40
            20
              0
                            89

                                      90

                                                91

                                                           92

                                                                     93

                                                                               94

                                                                                         95

                                                                                                   96

                                                                                                              97

                                                                                                                        98

                                                                                                                                  99
                  88
                        FY

                                  FY

                                             FY

                                                       FY

                                                                 FY

                                                                           FY

                                                                                      FY

                                                                                                FY

                                                                                                          FY

                                                                                                                    FY

                                                                                                                               FY
             FY




Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                     Admissions by Modality
                                                            FY ’99
  60,000
                     51,845
  50,000

  40,000

  30,000                                                                                      26,795

  20,000
                                                                                                                      10,234
  10,000                                       6,402                   5,481

          0
                       ATS                Residential             Methadone                Outpatient                   DAE



Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                          Admissions by Gender
                                          FY ’99 n=115,491
     Male
     73%




                                                                                                                         Female
                                                                                                                          27%



Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                             Female Admissions
                                         FY ’88 to FY ’99
                Thousands
          35                                                                                                                  31
                                                                                                          29        31
          30                                                                          28       28
                                                                  25        26
          25 20                    22         22       23
                         21
          20
          15
          10
            5
            0
          88

                    89

                              90

                                        91

                                                  92

                                                            93

                                                                       94

                                                                                 95

                                                                                           96

                                                                                                     97

                                                                                                               98

                                                                                                                         99
      FY

                FY

                          FY

                                     FY

                                               FY

                                                         FY

                                                                   FY

                                                                             FY

                                                                                       FY

                                                                                                 FY

                                                                                                           FY

                                                                                                                     FY
Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
          Admissions by Race/Ethnicity
                                        FY ’99 n=115,491
                                  White
                                  70%




                                                                                                                              Black
                                                                                                                               13%


                                                              Others                                 Latino
                                                                4%                                    13%

Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                                         Persons of Color
                                               FY ’88 to FY ’99
                  Thousands
          18
                                                                                                    16         16                    15
          16                                          14           15        15         15                                15
               Black                       13                                                                                             15
          14         12                                                                                                              14
          12 10                                                                                    13         13          13
                                                                                        11
          10                                                                 10
                                                   Latino
           8                                              8
           6                               7         7
                     6
           4  5
           2
           0
             FY88                   FY90                  FY92                   FY94                  FY96                   FY98

                                                               Blacks                         Latinos
Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
               Economic Status Indicators
                                        FY ’99 n=115,491
   80%                  73%                                74%


   60%
                                                                                            42%
   40%


   20%                                                                                                                   13%


    0%
                 Unemployed                   Income < $10,000                   No Insurance                   Receiving SSI


Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                                     Parenting Status
                                       FY ’99 n=115,491

           Parenting                                        Total                                       % of
         Status (FY 99)                                  Admissions                                  Admissions
                                                         (n=115,491)
        Has Children
                                                                53,848                                          47%
        (18 and under)
        Lives with                                              18,328                                          16%
        Children (<18)


Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
   Criminal Justice Involvement at Admission
               FY ’99 n=115,491
On Probation                                                                                                                     28%
                                                                                                                                 n=33,802

                                   1%
    On Parole
                                   n=1,387

                                        3%
     In Prison
                                        n=3,630


                                          4%
     Other CJ
                                          n=4,824


                   0%                 5%               10%                15%               20%                25%               30%

 Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
 Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
       Age and Education
         FY ’99 n=115,491
• Admissions were 35 years old, on
  average
• Two out of three admissions
  graduated high school
            Homeless Admissions by Modality
                    FY ’92 to FY ’99
                      Percent
             35
             30                                                                                          29
             25                                                                         25                               26               26
                                       23                                                                24              23
                       22                              21               21              21                                                22
             20
             15                                                         14
             10        10              10              10
               5       4               4               4                5               5                5               4                4
               0
                FY92            FY93             FY94            FY95             FY96            FY97             FY98            FY99

                                           Acute Treatment                       Residential                  Other

Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                         Primary Substance Used
                                                FY ’88 to FY ’99
            Percent
        70 61
                              58               56
        60                                                      52              52               54
                                                                                                                  51               50
        50                                                                               Alcohol
        40                                                                                                        30               32
                                                                24              25               26
        30                    20               22
                                                                                                                    Heroin
        20 1519                                    17               18
                                  18                                                 15               13          Cocaine
        10                                                                                                       10       9
                                                   4                4                5                6          6
         0
             3                    3                                                                    Marijuana          2
           FY92             FY93            FY94             FY95             FY96             FY97            FY98             FY99

                                  Marijuana                  Heroin               Cocaine                 Alcohol

Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
           Route of Administration for Heroin
                    FY ’92 to FY ’99
         Percent
80 72                  70                                                                                                                 67
                                          66                                   63                 65                 66
70                                                           62
60                                                                                                   Injection
50
40                                                           33                                   31                 30                   30
                       26                 29
30 23                                                                          24
                                                                                                  Inhalation
20
10
 0
 FY92                FY93               FY94               FY95              FY96               FY97               FY98              FY99

                                                       Inhalation                Injection


Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                                          
Admissions to Publicly-Funded             
                                          
  Treatment in FY ’99 were: Summary
• 27% Female
• 13% Black and 13% Latino
• 32% Primary Heroin Users
• 25% Injection Drug Users
• 73% Unemployed
• 16% Homeless
• 36% Involved with Criminal Justice System
                                        
                                        
      Treatment Outcomes                
                                 Introduction

• What are outcomes of publicly-
  funded substance abuse treatment?
  – Driver alcohol education
  – Residential rehabilitation
  – Outpatient counseling
  – Narcotic treatment
                                        
                                        
  Data Sources for Outcomes             
                                  Outcomes

• Substance Abuse Management
  Information System (SAMIS)
• Treatment Outcome and
  Performance Pilot Study I (TOPPS I)
• Methadone Quality Assurance
  System (MTQAS)
First Offender Driver Alcohol Education (DAE)
   Percent of DAE Clients in FY ’94 with Subsequent Drunk
   Driver Treatment Admissions in FY ’95-FY ’99 (N=9,656)

                                  Subsequent DUI
                               Treatment Admissions
                                       10%




                                            No Subsequent DUI Treatment Admissions
                                                             90%




Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                  Residential Rehabilitation
                      FY ’99 Employment Status
                               Percent Employed Percent Employed
                                  at Admission          at Discharge
 Women (n=1,824)                        3%                    25%
 Men (n=4,199)                          5%                    48%
 White (n=4,205)                        5%                    43%
 Black (n=1,026)                        3%                    40%
 Latino (n=594)                         3%                    34%
 Other (n=198)                          2%                    41%
 Total (n=6,023)                        5%                    41%
 All findings significant at p  .01 using Chi square test of
 significance

Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                   Residential Rehabilitation
TOPPS I Admission Versus Three Months Post-Discharge Assessment (N=160)*
                    59%
    60%




    40%

                                                     24%
                                                                                    21%
    20%                        17%
                                                                                                9%                 10%
                                                                                                                               2%
                                                                0%
      0%
               Used Substances                      Arrested                        Used ER                    Used Inpatient

                       Admission            3 Months Post Discharge

* All reported findings significant at p  .01 using Chi square test for all variables except “arrested”, which used the Fischer Exact Test.
Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Treatment Outcome and Performance Pilot Study I
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                                                                                                                          
                  Residential Rehabilitation                                                                              
                                                                                                                          
                                                                                                             Outcomes

     • Women in residential programs for
       pregnant and post-partum women
       in FY ’99 gave birth to 52 healthy
       babies
     • Massachusetts saved an estimated
       $66,000 per child in neonatal
       intensive care treatment*
*According to Mid Atlantic Medical Services, Inc. (MAMSI) and Matria Healthcare, Neonatal Intensive Care Units cost $2,000 a day.
The average stay per infant is 33 days which totals $66,000 per infant. Source: http://www.matria.com/press/061897.html
                            Outpatient Treatment
TOPPS I Admission Versus Three Months Post-Discharge Assessment (N=85)*

    60%
                                45%                                                              47%


    40%
                                                    29%


    20%

                                                                                                                   1%

      0%
                              Used Substances                                                    Arrested

                       Admission            3 Months Post Discharge

* All reported findings significant at p  .01 using Chi square test for all variables except “arrested”, which used the Fischer Exact Test.
Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Treatment Outcome and Performance Pilot Study I
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                               Narcotic Treatment
 FY ’99 MTQAS Admission Versus Quarterly Reassessment* (N=3,503)


    100%
                               84%                                                       85%

     80%
                                                  71%


     60%

     40%

     20%                                                                                                    7%

       0%
                         Not Employed Full-Time                                              Arrested

                             Admission           Reassessment
* All reported findings significant at p  .01 using Chi square test of significance.
Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Methadone Quality Assurance System
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                               Narcotic Treatment
 FY ’99 MTQAS Admission Versus Quarterly Reassessment* (N=3,503)

    60%
                                                                                                      51%
                                                                43%

    40%


                       20%                                                  19%
    20%
                                     8%
                                                                                                                   3%

     0%
                 Admitted to Hospital                       Admitted to ER                        Admitted to Detox

                             Admission           Reassessment
* All reported findings significant at p  .01 using Chi square test of significance.
Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Methadone Quality Assurance System
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                               
                               
      Treatment Outcomes:      
                            Summary

• Increased Sobriety
• Increased Employment
• Fewer Arrests
• Improved Health Status
                          Female Admissions
                                      FY ’92 to FY ’99
       Percent
 50

 40
                                                  28         28         27         28         28         28        27         27
 30                         24         26
       20        22
 20

 10

   0
    FY88 FY89 FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99


Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
                                Persons of Color
                                      FY ’92 to FY ’99
       Percent
20                                                17         17
                                       16                                16         16         16
           Black           14                                                                             15
15                                                                                                                    13         13
                12                                                       12         12         12         12          12         12
                                                             11
      10                                          10
10                                      8
               Latino 7
                6
      5
  5


  0
  FY88 FY89 FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99
                                                       Latino              Black

Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Treatment MIS
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services
     Trends in State and Federal Funding
          for BSAS FY ’88 to FY ’00
                                                Total Dollars in Millions

                                                                                                                                         42          43          43
                 37          40          38                                                                                  38
                                                     32                                              32          34
                                                                 28          28          30

                                                                                                           31          31                       33         33
                                                                                                                                   31
                                                                       26          27          28
                                               24          25

                       13          16
            7
          FY88        FY89        FY90        FY91        FY92        FY93        FY94        FY95        FY96        FY97        FY98        FY99        FY00



                                     Federal Block Grant Dollars                              BSAS State Appropriations


Data Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services
Prepared by: Health and Addictions Research, Inc. for the Massachusetts Department of Public Health, Bureau of Substance Abuse Services

				
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