Initiation and Engagement of Substance Use Disorder Treatment (IET)

Assesses new episodes of substance use disorder (SUD) in adults and adolescents 13 years of age and older who received:

Initiation of SUD Treatment: New episodes, after which the individual initiated treatment through an inpatient SUD admission, outpatient visit, telehealth or intensive outpatient encounter or partial hospitalization, or received medication within 14 days of diagnosis.
Engagement of SUD Treatment: New episodes, after which the individual initiated treatment and had two or more additional SUD services or medications within 34 days of the initiation visit.

Why It Matters

In 2022, 48.7 million individuals in the U.S. 12 years of age or older (approximately 17.3% of the population) were classified as having had an SUD within the past year.¹ Individuals with SUD are at increased risk of overdose, injury, soft tissue infections and mortality.² In 2021, drug overdose accounted for 106,699 deaths, representing a 14% increase in overdose deaths compared to 2020.³ Similarly, over 140,000 people die each year from excessive alcohol use.⁴

Early and regular SUD treatment, including medication therapy, has been demonstrated to improve outcomes for individuals with SUDs.,^5–8 but less than 20% of individuals with a SUD receive this important specialty care.^9,10

Results – National Results

Initiation of SUD Treatment - Alcohol Abuse or Dependence

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	36.6	38.1	42.1	38.8	40.8
2021	36.7	36.6	43.1	37.3	38.5
2020	39.1	38.8	44.2	37.8	39.2
2019	37.6	37.5	42.0	§	§
2018	36.6	37.5	41.6	37.9	39.7
2017	36.6	37.4	41	38.6	42.8

Initiation of SUD Treatment - Opioid Abuse or Dependence

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	42.5	40.7	58.3	33.2	33.2
2021	39.7	38.2	57.2	31.3	30
2020	40.0	38.8	56.3	31.3	30.8
2019	41.2	39.8	55.9	§	§
2018	40.1	41	52.5	31.4	32
2017	42	41.6	50.2	31.3	32.9

Initiation of SUD Treatment - Other Drug Abuse or Dependence

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	35.7	37.3	43	33.5	30.7
2021	34.1	34.6	42.7	31.1	28.9
2020	36.9	36.8	43.7	31.5	28.5
2019	37.1	37.8	43.1	§	§
2018	36.6	38	42.3	32	29
2017	37.1	38.4	42.4	32.6	32.3

Initiation of SUD Treatment (Total)

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	36.5	38	45	35.2	36.2
2021	34.1	34.6	44.2	33.1	32.8
2020	37.0	36.6	45.1	33.2	33.7
2019	36.0	36.4	44.0	§	§
2018	35.4	36.2	42.8	33.5	33.9
2017	36.6	36.7	42.3	33.9	36.1
2016	33.5	33.9	40.8	32.7	36.5
2015	33.3	34.5	38.2	32.7	35.2
2014	34.7	36.1	38.3	32.5	35.1
2013	37.6	40.3	38.2	33.7	37.8
2012	39.1	41.2	39.4	38.8	43.3
2011	40.2	40.6	39.2	41	47.6
2010	42.7	40.8	42.9	44.6	57.4
2009	42.7	46	45.6	46.2	57.4
2008	42.4	42.6	44.5	45.9	49.1
2007	44.5	46	45.6	50.3	56.5
2006	43.2	49	43.3	50.3	50
2005	44.5	45.8	40.7	50.9	52.3
2004	45.9	—	45.7	52.6	—

Engagement of SUD Treatment - Alcohol Abuse or Dependence

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	12.4	13.5	11.5	4.6	4.5
2021	12.3	13.3	11.3	5.1	5
2020	12.7	14.3	11.0	4.9	4.8
2019	12.4	13.7	11.1	§	§
2018	11.8	13.6	10.9	4.9	4.6
2017	11.8	13.7	10.6	4.6	4.3

Engagement of SUD Treatment - Opioid Abuse or Dependence

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	21.6	20.3	30.3	7.5	6.4
2021	18.9	18.5	28.4	8.1	5.2
2020	19.2	19.4	27.8	7.4	5.8
2019	19.5	20.0	28.1	§	§
2018	19.5	20.3	25.6	5.3	3.9
2017	20.1	21.2	22.2	4.8	3.8

Engagement of SUD Treatment - Other Drug Abuse or Dependence

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	12.2	13.6	12.3	3.9	3.1
2021	10.7	12.3	11.2	3.5	3
2020	11.7	13.8	11.2	3.7	2.8
2019	11.8	14.3	11.6	§	§
2018	12	13.9	11.7	3.7	2.6
2017	12.3	14.1	11.6	3.8	2.9

Engagement of SUD Treatment (Total)

Measure Year	Commercial HMO	Commercial PPO	Medicaid HMO	Medicare HMO	Medicare PPO
2022	13.1	14.2	14.9	5	4.6
2021	11.7	13	13.9	5.2	4.5
2020	12.6	14.0	14.1	5.1	4.5
2019	12.4	13.9	14.4	§	§
2018	12.2	13.8	14	4.5	3.9
2017	12.5	14.3	13.5	4.4	3.6
2016	11.3	12.9	12.5	3.6	3.4
2015	11.8	13.5	10.2	3.2	2.9
2014	12.8	14.2	11.3	3.3	3.5
2013	13.7	14.8	10.6	3.2	3.5
2012	13.6	14.6	10.8	3.1	3
2011	15.2	16	11.9	3.7	3.8
2010	15.6	16	14.2	3.7	3.8
2009	16.1	15.7	12.3	4.6	4.2
2008	16.2	16.2	12.4	4.3	9.4
2007	15.2	15.2	14.4	4.5	6.3
2006	13.8	16	11.7	4.5	7
2005	14.1	15.3	9.7	4.7	3.2
2004	15.5	_	11.9	7.1	_

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.

References

Substance Abuse and Mental Health Services Administration. 2023. “Key Substance Use and mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health.” HHS Publication No. PEP23-07-01-006, NSDUH Series H-58. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf
Bahorik, A.L., D.D. Satre, A.H. Kline-Simon, C.M. Weisner, C.L. Campbell. 2017. “Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System.” J Addiction Medicine 11(1),3–9.
Centers for Disease Control and Prevention. 2023. “Drug Overdose Deaths.” https://www.cdc.gov/drugoverdose/deaths/index.html
Centers for Disease Control and Prevention. 2022. “Deaths from Excessive Alcohol Use.” https://www.cdc.gov/alcohol/features/excessive-alcohol-deaths.html#:~:text=More%20than%20140%2C000%20people%20die,in%20the%20U.S.%20each%20year.
Kampman, K., K. Freedman. 2020. “American Society of Addiction Medicine (ASAM) National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update.” Journal of Addiction Medicine 14, no. 2S: 1–91, https://doi.org/10.1097/ADM.0000000000000633.
Reus, V. et al. 2018. “Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder.” American Journal of Psychiatry 175(1), 86–90. doi:10.1176/appi.ajp.2017.1750101
Department of Veteran Affairs, Department of Defense. 2015. VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders. Washington DC: Department of Veterans Affairs, Department of Defense.
Michigan Quality Improvement Consortium. August 2015. “Screening, Diagnosis and Referral for Substance Use Disorders.” Southfield (MI): Michigan Quality Improvement Consortium. 1 p.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2019. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use

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