Making our way towards “no wrong door”: Latent classes of substance use disorder treatment facilities in the United States

background: The SAMHSA “no wrong door” policy underscores the need to provide services for people with co-occurring disorders (COD) in both mental health and substance use disorder (SUD) treatment settings. Over 40% of individuals meeting SUD criteria have a COD. In this study, we assessed the proportion of SUD treatment services that have services needed for COD. 

methods: Using data from 14,056 facilities in the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS), we conducted latent class analyses (LCA) to identify empirically-based clustering. Facility indicators included availability of COD services (e.g. mental health, peer support, COD groups), counseling (e.g. motivational interviewing, cognitive behavioral therapy), and standard practices (e.g. case reviews).

results: LCA indicated a four-class solution as the most parsimonious model with good fit based on fit indices: including: (1) high intensity services (25%) with high probability of endorsing all items; (2) behavioral health services (28%) with lower probability of endorsing non-mental health items; (3) high peer support (20%) with lower probability of endorsing non-peer support items; and (4) low intensity services (27%) with low probability of endorsing all items.

conclusions: Only about half (53%) of facilities were in classes providing behavioral health services. In order to ensure that people with co-occurring behavioral health needs find “no wrong door”, factors acting as facilitators or barriers to incorporating behavioral health services into specialty SUD treatment facilities should be identified.