Heterogeneity of Mental Health Service Utilization and High Mental Health Service Use Among Women Eight Years After Initiating Substance Use Disorder Treatment

• Over 8 years after women entered substance use disorder treatment, 50% utilized mental health services.
• Up to 29% of women with co-occurring substance use disorders and mental illness receive no mental health services over time.
• Mental health service utilization patterns among women treated for substance use disorders are heterogeneous and dynamic.
• About 5% of women were treated for substance use disorders used a high amount of mental health services consistently over time.
• Mental health diagnoses and other factors shape high use of mental health services by women with substance use disorders.

ObjectiveThe aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use.MethodsData were provided by 4447 women treated for SUD in California during 2000–2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (> 6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns.ResultsIn 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p < 0.05) and employment (OR 0.53, p < 0.05) and positively associated with older age (OR 1.04, p < 0.001), homelessness (OR 1.68, p < 0.05), public assistance (OR 1.76, p < 0.01), outpatient SUD treatment (OR 3.69, p < 0.01), longer SUD treatment retention (OR 1.00, p < 0.01), treatment desire (ORs 1.46, p < 0.001), and co-occurring disorder diagnosis (ORs 2.89–44.93, p < 0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years.ConclusionsMental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services.