Association Between Integrated Treatment Services and Access to Detoxification and MOUD Across US Treatment Facilities.

Abstract

Integrated treatment services for co-occurring mental health and substance use disorders are recommended best practice, yet their relationship with facility-level provision of detoxification and medications for opioid use disorder (MOUDs) is not well understood. The researchers analyzed 2021-2023 National Substance Use and Mental Health Services Survey (N-SUMHSS) data from 49,623 facilities offering any substance use services. Multivariable logistic regression models examined associations between integrated services and availability of detoxification and MOUD, adjusting for facility characteristics and Chronic Care Model elements. Primary treatment focus (substance use, mental health, mixed) was evaluated as an effect modifier. Overall, 61.2% of facilities offered integrated services, 21.2% provided detoxification, and 56.0% provided MOUD. Among substance use-focused facilities, integrated services were associated with higher odds of offering detox (adjusted odds ratio [aOR] = 1.27, 95% CI 1.17-1.37) and MOUD (aOR = 1.44, 95% CI 1.34-1.56). Among mixed-focus facilities, integrated services were associated with higher odds of MOUD (aOR = 1.39, 95% CI 1.28-1.51) but not detoxification. Among mental health-focused facilities, integrated services were associated with lower odds of detoxification (aOR = 0.34, 95% CI 0.22-0.53) and did not predict MOUD availability. Facility type, ownership, and Chronic Care Model elements, including delivery system redesign, self-management support, and clinical information systems, were strong independent predictors of both outcomes. Integrated services may be associated with greater access to detoxification and MOUD in substance use-focused settings but appear insufficient within mental health-focused facilities; efforts to strengthen integrated care should account for facility focus and infrastructure capacity.