Graduation Semester and Year
Summer 2025
Language
English
Document Type
Dissertation
Degree Name
Doctor of Philosophy in Social Work
Department
Social Work
First Advisor
Christian Vazquez
Second Advisor
Micki Washburn
Third Advisor
Kyaien Conner
Fourth Advisor
Marcela Nava
Fifth Advisor
Jandel Crutchfield
Abstract
This dissertation investigated factors associated with treatment discontinuation of residential substance use programs for Black adults with co-occurring mental health and substance use diagnoses living in states that had expanded Medicaid versus states without expansion. This study explored and identified gaps in the research pertaining to treatment retention for Black adults since 2014, the year when Medicaid expansion began. The study focused on Black adults aged 18 or older who self-identified as Black or African American with a current diagnosis of co-occurring mental health and substance use diagnoses at the time of their discharge from a residential substance use treatment program. All participants had both mental health and substance use diagnoses at discharge and were in residential settings where treatment for alcohol and/or other substance use disorders were provided. More specifically, this study explored factors associated with treatment discontinuation from both co-occurring mental health and substance use diagnoses and residential substance use programs for Black adults. This study had two main objectives: (1) to explore and identify possible state (e.g., Medicaid expansion) and individual-level factors associated with treatment discontinuation among Black adults with co-occurring mental health and substance use disorders in residential substance use settings and (2) to investigate how treatment discontinuation may differ across selected years and states, to inform future, more targeted studies on health equity in substance use treatment outcomes.
A secondary quantitative analysis was employed, using a logistic regression to assess factors associated with treatment discontinuation for Black adults during 2014-2019, and 2022. After data cleaning for research question three, only Arizona, Connecticut, and North Carolina had remaining available data for this study. The Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Dataset: Discharges (TEDS-D) was used to answer the following research questions: (1) What factors are associated with treatment discontinuation among Black adults with co-occurring mental and substance use diagnoses in substance use residential settings from 2014 to 2019, accounting for whether a state expanded Medicaid or not? (2) Do the odds of discontinuing residential substance use treatment differ among Black adults with co-occurring mental and substance use diagnoses in 2014, 2018 and 2022, accounting for whether a state expanded Medicaid or not? (3) Do Black adults with co-occurring mental and substance use diagnoses who live in Arizona, Connecticut, or North Carolina have higher odds of discontinuing residential substance use treatment from 2014 to 2019?
Keywords
treatment discontinuation, factors, Black adults, Medicaid, Co-ocurring, Mental Health, Substance Use
Disciplines
Other Social and Behavioral Sciences | Public Affairs, Public Policy and Public Administration | Social Work
License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Scott, Gabrielle, "Factors Associated with Residential Treatment Discontinuation for Black Adults with Co-Occurring Mental Health and Substance Use Diagnoses Living in States with Expanded Medicaid Vs. States Without Expansion" (2025). Social Work Dissertations. 197.
https://mavmatrix.uta.edu/socialwork_dissertations/197
Included in
Other Social and Behavioral Sciences Commons, Public Affairs, Public Policy and Public Administration Commons, Social Work Commons