All ETDs from UAB

Advisory Committee Chair

Larry R Hearld

Advisory Committee Members

Allyson G Hall

Stefan G Kertesz

Stephen J O'Connor

Jeff M Szychowski

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Substance use disorders (SUDs) are a growing crisis globally and in the US, and place an enormous health, social, and financial burden on the nation. To address the complex nature of SUDs, treatment typically involves a combination of different types of services to address the medical, behavioral and social needs of the patient and care is often delivered by specialized SUD treatment facilities. Despite recommendations for a broad suite of services, individual facilities vary in the specific services that they offer. This study examined whether and why systematic differences exist between treatment facilities based on their service mix and whether such differences vary as a function of the external regulatory environment. Quantitative data about services offered by treatment facilities and external regulations were obtained from the National Survey of Substance Abuse Treatment Services (N-SSATS) for 2015-2018 and the Kaiser Family Foundation. Qualitative data were collected from 13 semi-structured interviews conducted with administrators of treatment facilities. The quantitative studies relied on latent class analysis and logistic regression models while the qualitative study used a deductive approach with thematic analysis. This research identified three distinct classes or service profiles among treatment facilities: comprehensive, non-medical, and intermediate service profiles, each with distinct organizational characteristics. The study also found that regulatory factors in the external environment exerted different types of pressures on treatment facilities and mechanisms like treatment facility licensing and accreditation were more likely to be associated with a comprehensive service profile, while state-level policies such as Medicaid expansion and civil commitment for substance use were less likely to be associated with the comprehensive profile. Results of the qualitative study further reinforced the role of the external environment on service mix and interviewees identified several environmental, organizational, and strategic factors that influenced the facility’s service mix and described critical challenges in delivering care to patients. Findings from this study will be helpful to policymakers as they design policies to address the growing SUD crisis and to practitioners who are tasked with making important decisions about organizational operations while ensuring patients receive the best care.