Substance use disorder treatment success: assessing patient-reported use improvement and provider-evaluated treatment completion

Background: Provider-evaluated substance use treatment completion and client-reported substance use improvement are standards in determining treatment success. The relationship between these two outcomes is anecdotally understood in practice. However, the relationship has not been empirically determined and factors related to provider/client conflicting assessments are unknown. This study investigates treatment success by investigating consensus and conflict between improvement and completion in a large national sample. Method: The present study is a cross-sectional retrospective evaluation of US substance use treatment episodes from facilities receiving public funding from 2015 to 2019 (N = 5,047,714). Episodes were mostly male (64.5%), aged 25–34 (34.4%), and White (58.5%). Conflict, consensus, and client factors associated with conflicting outcome evaluations were compared with differences in proportions and their 95% confidence intervals. Logistic regression was used to predict completion from improvement, adjusting for covariates. Results: For absolute percentages, clients and providers were in consensus in 48.3% of all episodes, 32.5% were in conflict, and 19.2% were missing. The adjusted analysis significantly predicted completion from improvement (aOR = 2.18, 95% CI = 2.17, 2.19). Importantly, outcome conflict demonstrated absolute meaningful associations with problem substance, referral source, employment status, service setting, and supplemental mutual-help group attendance. Conclusions: Completion and improvement are somewhat associated, but most likely represent separate factors of treatment success. Addressing factors associated with outcome conflict may improve client and provider consensus and increase successful recovery. Policies and programs can set standards aligned with a uniform definition of success accounting for use improvement.