Understanding the relationship between social determinants of health and adherence to substance use disorder treatment

This dissertation examined the role of documented social determinants of health (SDOH) in treatment engagement among commercially insured adults receiving medication treatment for opioid use disorder (OUD) between 2016 and 2019. Although social and structural factors are widely recognized as drivers of substance use outcomes, empirical evidence using administrative claims data remains limited due to incomplete capture of social risk. This research addressed that gap by evaluating both the presence of any documented SDOH and domain-specific and cumulative SDOH burden in relation to treatment retention. A retrospective cohort study using IBM® MarketScan® Commercial Claims data identified adults initiating medication treatment for OUD following a one-year washout period. Treatment retention over six months was evaluated using a time-to-event framework with a gap-based definition of discontinuation. The first analysis assessed whether documentation of any ICD-10-CM SDOH Z-code was associated with retention. The second analysis examined domain-specific SDOH categories and cumulative social burden. Across both analyses, documentation of SDOH was extremely limited, with fewer than two percent of treatment initiators having any recorded social determinant code. Documentation was not significantly associated with six-month retention in adjusted models. Age and geographic region demonstrated stronger associations with treatment continuity than documented social risk factors. Domain-specific analyses similarly found no significant associations, though sparse data limited statistical power. Findings suggest that claims-based documentation of social determinants in commercially insured populations is insufficient to capture true social adversity and may underestimate the impact of structural factors on treatment engagement. The results highlight a critical measurement gap in administrative data and underscore the need for improved social risk screening, standardized documentation practices, and integration of multiple data sources to advance research on structural determinants of substance use treatment outcomes.