Targeted Health Provider Placement Systems: Findings from an Online Substance Use Disorder Pilot

Background: 

The estimated 24 million U.S. residents who meet criteria for substance use disorders (SUD) present a considerable social problem that is known to cause significant financial and social burdens. Only 10% of those who meet criteria enter treatment annually, while an additional 1.1 million indicate that they feel as if they needed treatment but could not obtain it. Reasons for delaying or avoiding treatment entry include location, cost, and the stigma of seeking information regarding SUD treatment. These findings suggest that further efforts are needed to improve resources for treatment-seeking individuals. While procedures that standardize treatment recommendations based on client-needs using evidence-based knowledge have been shown to be feasible, effective, and to improve treatment outcomes, their utilization has been limited in referral to treatment (RT) settings. At present, assessment procedures for SUD treatment placement are often protracted, laborious, and susceptible to reliability concerns given their reliance on individual assessor recommendations, which can vary considerably despite manualized procedures and staff training.

Program background:  The described pilot project examined client characteristics, satisfaction, as well as utilization, of a computer-based treatment-referral system that aims to overcome a number of the earlier mentioned barriers.

Evaluation Methods and Results:  The study assessed the Computer Assisted Addiction Treatment Search (CAATS) system by recruiting treatment-seekers through organic (i.e., unpaid) online searches. Inclusion criteria included treatment-seeking for self (i.e., not for another), expected treatment entry within six months, and access to a computer, the internet, and an email account as well as availability for 4 online assessments within six months. Twenty recruited participants presented variability in racial makeup, gender, employment, and geography. Nearly all participants (90%) reported having health insurance. Available monthly contribution to treatment costs was minimal at $190 (SD=$300). All participants reported needing treatment for drug use with 75% reporting a need for alcohol treatment as well. Marijuana (75%), Alcohol (50%), and prescription drugs (50%) were the most frequently used substances. Participants reported using professional advice (100%), online (60%), and call-centers (40%) when seeking SUD treatment recommendations. Cost was reported as the greatest barrier (4.25 out of 5) to treatment entry with stigma the second strongest (3.5 out of 5). 25% of participants reported entering treatment since their initial entry into the study, with all reporting entering outpatient treatment. CAATS recommendations were utilized by 40% of study participants although cost issues were reported for all those who did. Not having time (50%) and not liking CAATS recommendations (50%) were reported as reasons for not contacting recommended providers.

Conclusions:  Online targeted treatment systems can reach a wide range of treatment-seeking individuals although online advertising and concerted marketing are likely needed to increase their reach. Provider targeting needs to address key barriers to be useful, and missing data about providers must be addressed to maximize such targeting. Matching algorithms must be tested for accuracy and appropriateness to ensure that users find recommendations useful.

Implications for research and/or practice:  Methods for providing targeted, anonymous, treatment recommendation for health and mental health disorders should provide and effective, efficient, option especially for highly-stigmatized conditions such as substance abuse and dependence.