Enhancing Treatment Retention in SUD Clinics

Among the most persistent challenges for substance use disorder (SUD) clinics is retaining patients in care, with treatment termination varying from 23 to 50 percent in outpatient programs. Although previous research has examined the factors that pose barriers to accessing care, little is known about the facilitators that sustain engagement.

A qualitative study recently published in the Journal of Substance Use and Addiction Treatment sheds new light on that question. Led by NYU Langone Health researchers, the study delves into aspects of patients’ therapeutic journey that extend beyond their clinical interactions with providers.

“By examining patient experiences and preferences in the early stages of their treatment, we aim to contribute insights that can inform outreach interventions, enhance treatment access, and improve engagement in SUD outpatient care,” says lead author Sugy Choi, PhD, an assistant professor of population health. “We want to help counselors achieve a better understanding of what really matters to their clinic populations.”

Investigating Patients’ Perspectives

The paper grew out of a larger study, Coaching for Addiction Recovery Enhancement (CARE), whose goal is to build organizational capacity in addiction treatment centers.

Supported by the National Institute on Drug Abuse, CARE’s facilitators are working with staff at 30 outpatient clinics around New York City and the Albany Capital Region to develop data-driven tools to enhance treatment outcomes and patient experience. The research team, led by NYU Langone behavioral scientist Charles J. Neighbors, PhD, MBA, an associate professor of psychiatry and population health, will make those tools available to clinics across New York State in collaboration with the Office of Addiction Services and Supports (OASAS).

For this portion of the study, the team conducted semistructured interviews with 34 patients attending nine outpatient SUD clinics in the CARE network. Clinics were selected based on urbanicity, size, and patient demographics to ensure a diverse sample. Inclusion was limited to patients in the first 180 days of treatment, a period of high risk for discontinuing therapy.

The interview guide was designed to elicit insights on why those patients chose to stay the course. Sessions were conducted by phone or video call and lasted 45 to 60 minutes. Transcripts were processed using qualitative analysis software to help identify patterns and themes in participants’ responses.

“We wanted to see if there were variations across demographic groups that might help us understand why some patients stick with treatment and others don’t,” Dr. Neighbors explains. “What we found instead were consistencies across all groups in factors that patients considered beneficial or counterproductive.”

Identifying What Works

The study identified three aspects of treatment that were crucial for patient engagement and retention. The first was what the team describes as a “supportive environment with a personalized recognition.” Participants emphasized the significance of compassion, a nonjudgmental approach, personal care, and positive interactions with providers and support staff.

Clinicians could exhibit these qualities verbally and nonverbally—or as one participant put it, “How they speak to you. Body language. Everything.” Interactions outside the therapeutic context were important as well. For example, participants cited the positive impact of receptionists greeting them by name, and the negative impact of prolonged wait times.

The second critical factor identified by the study was “practical assistance.” Participants expressed the value of aid in housing, employment, food, education, transportation, and advocacy. They also cited the significance of amenities within the clinic itself, such as coffee, snacks, and a comfortable space, as well as events such as movie days, pizza nights, and outings. These activities were seen as contributing to a sense of community and providing life-affirming experiences.

The third key factor for engagement and retention was “interpersonal dynamics.” Participants stressed the importance of clinicians understanding and respecting individual differences, maintaining confidentiality and boundaries, building trust, exhibiting cultural humility, and demonstrating reliability and consistency in interactions. “Patients expressed gratitude for service providers who established a strong personal connection,” says Dr. Choi.

By contrast, participants identified several approaches they found ineffective, including generic, “textbook” treatment methods, stigmatizing attitudes, and a strict belief in abstinence as the only valid approach to recovery.

Pointing Toward a New Paradigm

These findings, the authors suggest, align with existing literature on patient-centered care—an emerging treatment model that embodies principles such as a holistic and personalized focus, shared decision-making, and an enhanced therapeutic alliance.

“This approach has been associated with improved patient satisfaction, goal achievement, and reduced consequences from drug use,” Dr. Choi observes. “Our study helps explain its efficacy, and points toward ways in which it can help shape a more compassionate and responsive healthcare landscape.”