Variations in Acceptance of American Society of Addiction Medicine (ASAM) Continuum Levels of Care for Substance Use Disorder Treatment in an Urban Safety Net Primary Care Health Setting: A Qualitative and Quantitative Analysis and Implications for Health Equity.

Abstract

Objectives: To assess patients' demographic factors associated with declination of recommended American Society of Addiction Medicine (ASAM) Continuum levels of care and analyze patients' self-reported reasons for declination.

Methods: This cross-sectional observational study examined data collected during clinical care delivery in a safety net health system's primary care setting for patients receiving medication treatment and recovery support services for opioid and/or alcohol use disorder (OUD, AUD). We evaluated intake assessments to identify recommended levels of care, acceptance or declination of the recommendation, and self-reported reasons for declination. We stratified the acceptance data by demographic factors and analyzed reasons for declination to identify themes.

Results: Of 1399 completed intakes, 42% declined all ASAM levels of care as a complement to medication and within-clinic recovery support services. Patients who identified as non-White, male, and/or 60 years or older were significantly more likely to decline all levels of care. Among the 125 patients who provided a documented reason for declining, 26% endorsed work, financial, or family obligations; 26% indicated a preference for alternative forms of psychosocial support; and 14% indicated possible interest in the future.

Conclusions: It is important for substance use disorder treatment providers and policymakers to understand the barriers patients face regarding engagement in treatment and reasons for the declination of services. Recognizing variations in care acceptance by demographic factors can help us understand common barriers and guide future directions to address health inequities.