Who goes to alcohol and drug treatment? - Understanding utilization within the context of insurance

Objective: This study assesses the differential roles of demographic characteristics, problem severity, motivational factors and insurance in entrance into alcohol and drug treatment. Method: A probability sample of adult problem and dependent drinkers from a Northern California county (N = 672) and consecutive adult intakes from the county's public (n = 298) and private (n = 628) alcohol and drug treatment programs. Interviewers conducted telephone screening for individuals meeting problem-drinking criteria in the general population; in-person interviews were conducted for those who screened positive, and also for individuals entering treatment. Results: Insurance did not play an independent role in treatment entry. In logistic regression analysis, using a model from the medical utilization literature, black ethnicity (odds ratio [OR] = 2.98, p <.001); older age (OR = 4.67, p <.001); less education (OR = 1.81, p <.01); legal (OR = 7.46, p <.001) and work (OR = 3.57, p <.001) pressures; higher psychiatric (OR = 4.03, p <.001) and drug (OR = 3:04, p <.001) severity; and social consequences (OR = 1.35, p <.01) predicted treatment entry. Interventions from legal sources (OR = 6.22, p <.01) were related to entering treatment for the uninsured; legal (OR = 7.02, p <.001), workplace (OR = 6.01, p <.001) and family (OR = 1.62, p <.05) pressures were related for the insured. Conclusions: Social consequences, rather than severity of dependence, in both insured and uninsured problem drinkers are important predictors of treatment entry when traditional utilization measures are controlled. Public programs play a crucial part in the alcohol and drug treatment system, and their viability is important as health policy changes.