Admitted to treatment without diagnosis: The status of known diagnoses in US addictions treatment centres

Abstract

Background: Diagnostic and treatment gaps exist for those with substance use disorders (SUD). SUD diagnostics in treatment have been critically under-investigated. We investigated known diagnoses in US addiction treatment centres receiving state or federal funding. Methods: Cross-sectional risk factor analysis of variables associated with known diagnoses in US inpatient and outpatient treatment facilities receiving public funding from 2000 to 2014 (N = 8,692,362). Results: Of all clients, 59.68% had unknown diagnoses. However, 14 states reported zero diagnostic data, representing the majority of unknown diagnoses. Of the reporting states (n = 4,161,021), 16.05% had unknown diagnoses. Those with known diagnoses were represented by four subcategories of SUD (73.22%), No Diagnosis (0.81%), Alcohol Intoxication (1.36%), and Mental Health (8.57%). Uninsured status was one meaningful association and was less likely to have a known diagnosis. Insurance status, referral source, service setting, and wait to admission significantly predicted known diagnosis (p < 0.0001). Conclusions: A large proportion of admissions are missing diagnoses. Many states do not report any diagnostics. Variables predictive of a known diagnosis highlight administrative inconsistencies. Policies requiring SUD diagnosis documentation can improve assessment of treatment appropriateness and level of care, programme evaluation, and inform the funding allocation for relevant treatment efforts.