Garrison Yunkyoung L, Luo Yan, Sahker Ethan
Department of Psychology, Bates College, 2 Andrews Rd, Lewiston, ME, USA.
Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Int J Drug Policy. 2024 Feb;124:104312. doi: 10.1016/j.drugpo.2023.104312. Epub 2024 Jan 3.
Despite efforts to increase substance use disorder (SUD) treatment provision in the United States (US), the extent to which traditional mental health (MH) facilities offer SUD treatment remains unclear. In the present study, we analyzed the trend in SUD treatment integration among traditional MH facilities in the US from 2014 to 2020 and identified facility-level factors associated with SUD treatment provision.
Data were extracted from the National Mental Health Services Survey (N-MHSS). A timeseries logit trend analysis for the multi-year dataset (2014-2020) was conducted to assess a yearly change in odds of SUD treatment provision. With the 2020 survey data, analyses were conducted to identify the differences between facilities offering SUD treatment and facilities not offering such treatment. Finally, exploratory multivariable logistic regression was conducted to estimate odds of SUD treatment provision by facility variables.
US MH facility SUD treatment provision went from 51.7 % (2014) to 57.9 % (2020). A mean sample of 12,312 US MH facilities over seven years, demonstrated a significant but small yearly increase in SUD treatment provision (OR = 1.04, 95 % CI = 1.03, 1.04). Important facility characteristics related to SUD treatment provision for facilities without a core SUD focus were MH diagnostics offered (OR = 2.03), dual-diagnosis program offered (OR = 3.65), state drug/alcohol license maintained (OR = 6.66), and VA setting (OR = 7.94).
Despite incremental progress in integrating SUD treatment services into US MH facilities, the SUD treatment gap remains large. Training and service development incentives for identified characteristics could help further reduce the treatment gap.
尽管美国在努力增加物质使用障碍（SUD）治疗服务的提供，但传统心理健康（MH）机构提供SUD治疗的程度仍不明确。在本研究中，我们分析了2014年至2020年美国传统MH机构中SUD治疗整合的趋势，并确定了与提供SUD治疗相关的机构层面因素。
数据从国家心理健康服务调查（N-MHSS）中提取。对多年数据集（2014 - 2020年）进行时间序列逻辑趋势分析，以评估提供SUD治疗几率的年度变化。利用2020年的调查数据，进行分析以确定提供SUD治疗的机构与不提供此类治疗的机构之间的差异。最后，进行探索性多变量逻辑回归，以通过机构变量估计提供SUD治疗的几率。
美国MH机构的SUD治疗提供率从（2014年的）51.7%升至（2020年的）57.9%。七年间平均12312家美国MH机构的样本显示，SUD治疗提供率有显著但微小的年度增长（OR = 1.04，95% CI = 1.03，1.04）。对于没有核心SUD重点的机构，与提供SUD治疗相关的重要机构特征包括提供MH诊断（OR = 2.03）、提供双重诊断项目（OR = 3.65）、保持州药物/酒精许可证（OR = 6.66）以及退伍军人事务部环境（OR = 7.94）。
尽管将SUD治疗服务整合到美国MH机构方面取得了渐进式进展，但SUD治疗差距仍然很大。针对已确定特征的培训和服务发展激励措施可能有助于进一步缩小治疗差距。
