Characteristics associated with forced treatment discontinuation among people who use drugs in Rhode Island.

Abstract

A barrier to remaining in substance use treatment in the U.S. is abstinence-based policies, which can lead to premature treatment termination. In this study, we examine factors associated with forced treatment discontinuation due to substance use among participants in the Rhode Island Prescription and Illicit Drug Study (RAPIDS). We examined baseline data from RAPIDS participants (who enrolled between August 2020 and February 2023) and who reported any history of enrollment in substance use treatment programs. Modified Poisson regression was used to assess sociodemographic, drug use behavior, and clinical characteristics associated with forced treatment discontinuation due to substance use. The type of treatment from which participants were removed and the drug(s) that were implicated in the removal were also summarized. Among 406 eligible participants, 96 (24 %) experienced forced treatment discontinuation due to drug or alcohol use. The most frequently reported program from which participants were removed was residential treatment (75 %). The most frequently reported drug that was implicated in the removal was crack cocaine (33 %). In the modified Poisson analysis, regular use of powder cocaine was associated with experiencing forced treatment discontinuation (adjusted prevalence ratio = 1.50; 95 % confidence interval: 1.05, 2.15). Forced treatment discontinuation due to substance use is common, particularly in residential drug treatment. Our findings suggest a need for enhanced access to evidence-based treatments for stimulant use disorders. Persisting racial/ethnic disparities in treatment access underscores the need for strategies to ensure racial and ethnic equity in substance use treatment access and retention in care.