Association of structural factors with provision of non-English language services in substance use disorder treatment facilities in the USA: a cross-sectional study.

Abstract

The substance use disorder (SUD) crisis continues to be a public health challenge in the USA, disproportionately affecting culturally and linguistically diverse (CALD) populations. Understanding how structural factors contribute to providing linguistically competent SUD treatment can guide efforts to incorporate treatment provisions tailored to the specific needs of diverse CALD communities. This study examines the association of structural factors, namely ownership type and receipt of government funding, with facility-level provision of SUD treatment in non-English languages in the USA. A cross-sectional study using deidentified facility-level data from the 2019 National Survey of Substance Abuse Treatment Services (N-SSATS) dataset. SUD treatment facilities from all 50 US states and the District of Columbia. Of 15 961 facilities in the 2019 N-SSATS dataset, 14 993 were selected for inclusion in our study. The main outcome was a binary indicator of the provision of SUD treatment services in languages other than English. To assess the association between structural factors and the provision of SUD treatment services in non-English languages, we ran generalised linear mixed models, controlling for state- and facility-level variables, to estimate adjusted odds ratios (aORs). Of 14 993 SUD treatment facilities nationally, 7864 (52.45%) offered non-English language SUD treatment services. Private for-profit facilities had significantly lower odds of offering non-English language services than private non-profit facilities (aOR=0.59; 95% CI 0.54 to 0.65). Facilities that received government funding had significantly higher adjusted odds of providing non-English language services compared to those that did not (aOR=1.45; 95% CI 1.32 to 1.59). Structural factors, including ownership type and government funding, were associated with the provision of SUD treatment services in non-English languages. Our findings highlight the potential role of these structural factors in shaping the capacity to provide services in non-English languages in SUD care settings. Future research is needed to better understand how changes in funding mechanisms or ownership type may facilitate the provision of non-English-language treatment services across SUD facilities.