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Implementation of comprehensive services as a mediator and race and ethnicity as a moderator of access and retention in addiction health services


Increasing evidence has suggested that well-resourced programs are more likely than low-resourced programs to deliver comprehensive care to individuals with co-occurring conditions and achieve greater client access and retention. But there is limited understanding of the service delivery process that allows high-capacity programs to reduce their wait times for treatment entry and their rates of dropout.


To examine the indirect association of program capacity factors with wait time and retention via mental health and HIV prevention services in publicly funded addiction health services (AHS).


We conducted multilevel cross-sectional analysis of 108 publicly funded program data merged with Los Angeles County Participant Reporting System data from 2010 to 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test direct and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention).


Findings show that compared to Whites, Latinos and African Americans served in high-capacity programs reported shorter wait times and higher retention rates. As hypothesized, the role of HIV testing and mental health service coordination played an indirect role in the relationship between program capacity and shorter wait times.


Findings suggest that coordinated comprehensive services in AHS may contribute to reduction of outcome disparities in access to care. Delivery of comprehensive care may allow programs to develop effective networks to reduce wait time. Implications for health-care reform implementation and program planning are discussed.


This study was funded by the National Institute on Drug Abuse (R21DA035634-01).

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Correspondence to Erick G Guerrero.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Guerrero, E.G., Fenwick, K., Grella, C. et al. Implementation of comprehensive services as a mediator and race and ethnicity as a moderator of access and retention in addiction health services. Addict Sci Clin Pract 10 (Suppl 1), A18 (2015).

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