Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

Abstract

Background and aims: Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them.

Design: National-level registry-based retrospective cohort.

Setting and participants: Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266).

Measurements: Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic.

Findings: A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups.

Conclusions: In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.

Keywords: administrative data; care trajectory; latent class growth analysis; longitudinal analysis; substance use disorder treatment utilization; treatment careers.

FIGURE 1

Trajectories of substance use treatment utilization since first admission, seven class solution (n = 6266). Note: Class 1 = early discontinuation (32%); class 2 = less than a year in treatment (19.7%); class 3 = year-long episode, without recurrence (12.3%); class 4 = long first treatment, or immediate recurrence (6.3%); class 5 = recurrent and decreasing (14.2%); class 6 = early discontinuation with recurrence (9.9%); class 7 = recurrent after long between treatments period (5.7%).