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APHA Scientific Session and Event Listing

Lena Lundgren, PhD¹, Robert Schilling, PhD², Lisa Sullivan, PhD³, Deborah Chassler, MSW¹, Jamie Wyatt, MSW¹, and Julie Witas, MSW¹. (1) School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215, 617-353-1654, llundgre@bu.edu, (2) School of Public Policy and Social Research, UCLA, BOX 951656, 5220 Pub Policy Bldg, Los Angeles, CA 90096, (3) School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118

Heroin use among women is a public health concern, due both to increased injection-related AIDS cases among women and the increased number of women reporting heroin use. Using the health services utilization model, a conceptual model which proposes that entry into the healthcare system is predicted by predisposing, enabling and need factors, this study examined drug treatment entry for women IDUs.

Patterns of drug treatment entry for 10,498 women IDUs who entered the Massachusetts drug treatment system from 1996-2002 were examined using stepwise logistic regression analysis to examine the relative importance of predisposing, need, and enabling factors, on type of treatment entered. Predisposing factors included age, race/ethnicity, education, parental status; needs factors included level of drug use and homelessness; and enabling factors included health insurance, employment, and use of criminal justice, mental health and child welfare services.

Tests for goodness-of-fit identified that enabling factors consistently had the strongest association with type of treatment entered. Enabling factors were the only factors with a C-statistic over .8, demonstrating a significant goodness of fit. These models correctly predicted type of treatment entered 75-86% of the time. Hence, enabling factors such as health insurance status and use of other services, rather than predisposing or need factors, had the strongest association with treatment utilization for women IDUs. Recommendations for improving access to substance abuse treatment through advancements in research and policy will be discussed.

Learning Objectives: Participants will be able to

• Understand the application of the health services utilization model in examination of drug treatment entry;
• Discuss study findings related to predisposing, need, and enabling factors in patterns of drug treatment entry for women IDUs; and
• Articulate implications of study findings which indicate the existence of a three-tiered drug treatment system, with residential treatment being the primary service for those mandated to treatment, methadone maintenance the primary treatment for those with access to health insurance and or mandated children’s services, and continuous cycling through detoxification for those women with no links or access to other service systems.

Presenting author's disclosure statement:

Any relevant financial relationships? No