The effect of legal mandates on substance use disorder treatment completion among older adults.

Objective: This study seeks to determine the relationship between referral type (legally mandated versus non-mandated) and substance use disorder (SUD) treatment completion among older adults and by primary substance used.Method: We used data from the Treatment Episode Data Set - Discharges (TEDS-D) from 2011. Using data for persons age 55 and over (n = 104,747), we used propensity score matching (PSM) to address selection bias and attenuate the likelihood of a type I error. Logistic regression models estimated the effect of referral type on treatment completion based on treatment for a primary substance for five categories of substances.Results: In the matched sample, those who faced treatment mandates had 71% greater odds of completing treatment compared with those who entered treatment voluntarily (OR =1.71, 95% CI [1.64, 1.79]). Based on the primary drug used, odds of treatment completion were highest for alcohol, with 86% greater treatment completion for the mandated individuals compared with those entering treatment without a legal mandate (OR =1.86, 95% CI [1.75, 1.97]).Conclusion: These findings suggest that the motivating influence of treatment mandates may encourage completion of SUD treatment among older adults. Although the legal mandates for treatment are punitive, they may act to keep older adults with SUD engaged in treatment, an important factor as treatment completion is inversely related to relapse of a SUD.

Adolescent Neighborhood Environments and Latino Intraethnic Disparities in Trajectories of Serious Violent Behaviors.

The purpose of this study was to describe the longitudinal trajectories of risk for serious violent behaviors among Latinos of different ancestry in the United States and to examine the impact of neighborhood perceptions, socioeconomic status (SES), and racial/ethnic and immigrant concentration during adolescence in long-term risk. Guided by sociological theories and life-course frameworks, we utilized data from Mexican (n = 755), Cuban (n = 182), Puerto Rican (n = 219), and other Latino (n = 289) respondents who participated in all waves of the National Longitudinal Study of Adolescent to Adult Health. Stratified, weighted, multilevel growth curve models were conducted in Stata 14 MP to determine unadjusted and adjusted trajectories between 13 and 32 years of age for each ancestry group by sex. Violent behaviors decreased over time, and were lower among females of all groups. Puerto Ricans and Cubans had higher risk than Mexicans or other Latinos. Neighborhood factors did not have consistent effects across groups. Neighborhood satisfaction reduced risk among most groups, while social cohesion increased violent behaviors among Mexicans. Neighborhood economic well-being (SES) and proportion of non-Latino Whites had no impact among any group. Living in predominantly Black neighborhoods during adolescence reduced the risk into adulthood among Puerto Ricans, but increased it among other Latinos. Higher neighborhood immigrant concentration was related to higher risk among other Latinos. Initial and long-term risk for violent behaviors differed across Latino ancestry, with slower decreases among Puerto Ricans and Cubans. The impact of neighborhood perceptions, SES, and racial/ethnic and immigrant composition was inconsistent.