Multi-Level Modeling of the Treatment Gap

Investigator: Laura Schmidt, PhD
Sponsor: Brandeis University

Location(s): United States


Investigate the factors that explain the heterogeneity in alcohol and drug disorders, treatment seeking, and recovery across geographic areas, racial/ethnic groups and gender groups. This project conducts secondary analyses of the NESARC and NLAES to study the dynamic interaction of factors at both the individual level and societal/health system level, specifically: state policies, public financing, health system organization, and state/area socio-economic characteristics. To understand the influence of these contextual level factors, the study will employ hierarchical multi-level analytical techniques, modeling the behavior of individuals as nested within social and geographic environments. The analytic approach is informed by theories of treatment seeking, the social determinants of health, and research on recovery in treated and untreated populations. 
The Specific Aims are to: AIM 1: describe the variation in treatment need, treatment utilization (formal and informal services), and treatment gap across the 50 states, and identify the contextual factors (policy, financing, health system organization, and socio-economic) that explain the observed variation, controlling for demographic and other differences across states. This aim will involve cross-sectional and trends analyses of 1990-91 NLAES and 2001-02 NESARC. AIM 2: analyze how characteristics of individuals (particularly race/ethnicity and gender) interact with state and area contextual factors (policy, financing, health system organization, and socio-economic) to determine the probability that individuals with alcohol and drug use problems will recognize the need for care, seek care, and receive care. This aim will be addressed with cross-sectional analyses of NLAES and the 2001-02 NESARC. AIM 3: assess the impact of the state-level treatment gap and other area contextual factors on the probability of individual remission from alcohol and drug disorders and problems, all other things equal. This aim will involve longitudinal analysis of prospective data gathered on the 2004-2005 NESARC controlling for cohort information from the 2001-2002 NESARC. 
The treatment gap is a pressing problem in substance abuse health services research today, and yet there are significant limitations in our understanding of the problem. The NLAES and NESARC surveys offer an unprecedented opportunity to understand these dynamics since the surveys are based on representative samples of the community-at-large rather than a treated population and the NESARC collects longitudinal data on its community sample.