Dropout from Substance Use Disorder Treatment at a Swedish Private Care Institution and Its Associated Risk Factors

The drop-out rate for inpatient treatment for substance use disorder continues to be a significant issue. To increase the knowledge about drop out in different settings, this study's objective was to quantify the association for the previously identified risk factors of age, sex, and time in treatment at a private care institution offering substance use disorder treatment in Sweden.

This retrospective cohort study of clinical record data included all 1334 adult clients who were discharged from substance use disorder treatment between 1 January 2014, to 30 June 2022, at one privately operated treatment institution. Drop out was defined as treatment terminated before the planned end. The association between three potential risk factors and drop out was analysed in a multivariable logistic regression model. Estimates were reported as marginal risk ratios (95% confidence intervals).

Of 1334 discharged clients, 34% dropped out, corresponding to 38% of females and 33% of males. Approximately 52% of clients dropped out within 30 days, 42% dropped out between 30 and 89 days, and around 15% from 90 days and onwards. In the multivariable model, both time in treatment (3.08 [2.34, 3.83] for 30 to 89 days vs 90 days and 3.55 [2.72, 4.39] for <30 days vs ⩾90 days) and age (1.19 [1.14, 1.23] for one decade) showed a strong inverse association with drop out. The results did not support an association between sex and drop out (1.05 [0.89, 1.22]).

The risk for drop out is higher earlier in the treatment and for younger clients, so to reduce the drop out at private institutional care it is important to implement extensive interventions early in the treatment programme to increase the motivation for clients, particularly younger ones, to remain in treatment.