Substance abuse treatment facility's neighborhood effects on outpatient's treatment program completion

Patient dropout from alcohol and drug treatment programs has been recognized as one of the most significant factors that determine the effectiveness of treatment. Some individual patient characteristics documented as factors that are linked to treatment attrition include: demographic characteristics, substance use patterns, and other elements such as psychiatric conditions, etc. Research also documented that dropout is associated with referral sources. Patients referred by the legal system, for instance, can feel pressured to participate and tend to stay longer in treatment programs. It is noticeable, however, that studies documenting those factors are largely based on the analysis of individual-level attributes, and have not paid attention to contextual effects, such as neighborhood environment, on attrition. In this study, we explored treatment facility neighborhood socioeconomic conditions and their effects on patient treatment outcomes. Using 9794 outpatient discharge records with 56 treatment facilities in Cook County, Illinois, gathered by the Illinois Division of Alcoholism and Substance abuse, in conjunction with the 2000 census tract level data, multilevel models were used to examine the effects of facility neighborhood economic status (i.e., concentrated affluence, disadvantage, and stability) on patient likelihood of treatment program completion, controlling for patient demographics and other covariates. We found that a treatment facility's neighborhood stability is positively associated with treatment completion only for those who are referred by themselves or by relatives. Facility neighborhood stability is not related with treatment completion among those who are referred by the justice systems or state agencies or organizations.