33. Treatment Initiation and Engagement for Youth With Substance Use Disorders


      The prevalence of substance use disorder (SUD) is rising among adolescents and young adults. Quality of treatment varies widely, and little is known about rates of timely treatment initiation and engagement. We aimed to determine rates of treatment initiation and engagement for adolescents and young adults with SUD using specifications from the corresponding 2019 Medicaid Adult Core Set quality measure (IET-AD).


      We used a sample of publicly insured adolescents (13-17 years) and young adults (18-25 years) across 10 states from the IBM Watson/Truven MarketScan Medicaid 2018 data. Using measure specifications, we identified new SUD diagnoses (index episode in any clinical setting with no diagnosis in the preceding 60 days) and treatment initiation and engagement (defined as ≥1 claim within 14 days and ≥2 claims within 34 days of diagnosis, respectively, where claims with SUD diagnosis may or may not include specific behavioral or medication treatment). We calculated unadjusted treatment rates and then used multivariable analysis adjusting for sociodemographic and comorbid clinical conditions to calculate adjusted rates.


      We identified 33,072 Medicaid-insured youth with a new SUD diagnosis between January-November 2018, including 13,411 (41%) adolescents and 19,661 (59%) young adults. Overall, 51% were male; 55%, non-Hispanic white; 33%, non-Hispanic black; and 3%, Hispanic. Use disorders included cannabis (65%), alcohol (20%), opioid (11%), and other (32%), and 22% had polysubstance use. The adjusted treatment initiation rates for adolescents and young adults were 24% and 27% for any SUD; 20% and 36%, opioids; 26% and 25%, cannabis; 18% and 21%, alcohol; and 13% and 18%, other substances (p<0.05 for differences between adolescents and young adults for all SUDs). Among those initiating treatment, adjusted engagement rates for adolescents and young adults were 65% and 62% for any SUD; 70% and 69%, opioids; 68% and 61%, cannabis; 58% and 58%, alcohol; and 51% and 53%, other substances (p<0.05 for any SUD and cannabis).


      Three-fourths of adolescents and young adults do not receive timely initiation of treatment for SUDs. Once in treatment, a majority meet performance expectations for engagement, but there remains room for improvement. Drivers for successful SUD treatment initiation and engagement among youth should be further investigated.

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