Chavez C Leonardo Jimenez, Peltier MacKenzie R, McKee Sherry A
Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 5B, New Haven, CT, 06510, USA.
VA Connecticut Healthcare System, Mental Health Service, West Haven, CT, USA.
Biol Sex Differ. 2025 Jul 22;16(1):56. doi: 10.1186/s13293-025-00734-3.
Social determinants of health (SDOH) and clinical severity factors are known to shape substance use disorder (SUD) treatment outcomes, yet limited research has explored how these influences differ by sex. Understanding these differences is important to improving treatment equity and outcomes in publicly funded treatment systems.
This study analyzed data from the 2018-2022 Treatment Episode Data Set-Discharges (TEDS-D), a national dataset of adults discharged from publicly funded SUD treatment programs. Sex-stratified binary logistic regressions were used to examine predictors of two outcomes: treatment non-completion and substance use at discharge. Predictors included SDOH (i.e., employment, education level, housing status, criminal justice involvement, prior treatment history, marital status, health insurance coverage and treatment duration) and indicators of SUD severity (e.g., age at first use, polysubstance use, and co-occurring psychiatric disorders).
Both SDOH and clinical severity indicators were significantly associated with poorer treatment outcomes, with distinct patterns by sex. Women showed more consistent risk for poor treatment outcomes across predictors, including unemployment, psychiatric comorbidities, and polysubstance use, while lack of prior treatment history was the strongest predictor of substance use at discharge and dropout for men. Other predictors, such as housing instability, criminal justice involvement, and later-onset substance use, were also associated with increased risk of non-abstinence and dropout, with notable sex differences. Health insurance coverage was associated with better outcomes for both sexes, with the protective effect more consistent in women.
These findings emphasize the need for sex-informed treatment approaches that address both social determinants of health and clinical complexity. Tailoring care to the unique risks and contexts of men and women may improve retention and reduce substance use at discharge, particularly in publicly funded systems. Highlights We examined social determinants of health (SDOH), and substance use disorder (SUD) severity-related predictors of substance use and treatment completion in a national sample of approximately 7 million adults. Women demonstrated more consistent vulnerability across predictors, including unemployment, co-occurring psychiatric disorders, and polysubstance use. For men, lack of prior treatment for SUD was the most consistent predictor for substance use at discharge and treatment dropout. Housing instability, access to healthcare, and financial barriers showed sex-specific effects, with women generally experiencing great risk of unsuccessful treatment. Findings highlight the importance of improving SUD care to address sex-specific risks and structural barriers, especially in publicly funded systems. Plain English Summary Substance use treatment is not a one-size-fits-all process. Recovery is shaped by both structural challenges, such as housing instability or limited access to care, and the clinical severity of substance use. These factors influence whether someone completes treatment and stays abstinent, and they often affect men and women in different ways. In this study, we analyzed data from approximately 7 million publicly funded substance use treatment episodes across the United States. We looked at how social determinants of health (e.g. employment status, education, housing, access to treatment) and clinical factors (e.g. age of substance use onset, psychiatric comorbidities and polysubstance use), were associated with two key outcomes: whether a person completed treatment and whether they reported use of their primary substance at the end of care. We found that women often faced greater challenges, especially regarding unemployment, co-occurring mental health conditions and using more than one type of substance. For men, being new to treatment was a strong predictor of poorer treatment success. These findings demonstrate the need for treatment programs to offer support that meets men and women where they are, considering the different barriers and challenges each group may face along the path to sustained recovery.
已知健康的社会决定因素（SDOH）和临床严重程度因素会影响物质使用障碍（SUD）的治疗结果，但探索这些影响如何因性别而异的研究有限。了解这些差异对于改善公共资助治疗系统中的治疗公平性和结果非常重要。
本研究分析了2018 - 2022年治疗事件数据集 - 出院（TEDS - D）的数据，这是一个来自公共资助的SUD治疗项目出院成人的全国性数据集。采用按性别分层的二元逻辑回归来检验两个结果的预测因素：治疗未完成和出院时的物质使用。预测因素包括SDOH（即就业、教育水平、住房状况、刑事司法参与、既往治疗史、婚姻状况、医疗保险覆盖范围和治疗持续时间）以及SUD严重程度指标（例如首次使用年龄、多物质使用和共病精神障碍）。
SDOH和临床严重程度指标均与较差的治疗结果显著相关，且存在明显的性别差异模式。女性在各预测因素中显示出更一致的治疗结果不佳风险，包括失业、精神疾病共病和多物质使用，而缺乏既往治疗史是男性出院时物质使用和退出治疗的最强预测因素。其他预测因素，如住房不稳定、刑事司法参与和较晚开始使用物质，也与戒断失败和退出治疗的风险增加相关，且存在显著的性别差异。医疗保险覆盖范围与两性的较好结果相关，女性的保护作用更一致。
这些发现强调了需要采用考虑性别的治疗方法，既要解决健康的社会决定因素，又要应对临床复杂性。根据男性和女性的独特风险和情况量身定制护理，可能会提高留存率并减少出院时的物质使用，特别是在公共资助系统中。要点我们在一个约700万成年人的全国样本中，研究了健康的社会决定因素（SDOH）以及与物质使用障碍（SUD）严重程度相关的物质使用和治疗完成的预测因素。女性在各预测因素中表现出更一致的易感性，包括失业、共病精神障碍和多物质使用。对于男性，缺乏SUD既往治疗是出院时物质使用和治疗退出的最一致预测因素。住房不稳定、获得医疗保健的机会和经济障碍显示出性别特异性影响，女性通常面临治疗不成功的更大风险。研究结果强调了改善SUD护理以应对性别特异性风险和结构障碍的重要性，特别是在公共资助系统中。通俗易懂的总结物质使用治疗不是一个一刀切的过程。康复受到结构挑战（如住房不稳定或获得护理的机会有限）以及物质使用的临床严重程度的影响。这些因素影响一个人是否完成治疗并保持戒断，并且它们通常以不同方式影响男性和女性。在本研究中，我们分析了来自美国约700万公共资助的物质使用治疗事件的数据。我们研究了健康社会决定因素（如就业状况、教育、住房、获得治疗的机会）和临床因素（如物质使用开始年龄、精神疾病共病和多物质使用）如何与两个关键结果相关：一个人是否完成治疗以及他们在护理结束时是否报告使用其主要物质。我们发现女性通常面临更大的挑战，特别是在失业、共病心理健康状况以及使用不止一种物质方面。对于男性，初次接受治疗是治疗成功率较低 的一个强有力预测因素。这些发现表明治疗项目需要提供支持，以满足男性和女性的现状，考虑到每组在持续康复道路上可能面临的不同障碍和挑战。
