Sex differences in predictors of substance use disorder treatment completion among Veterans in community-based programs

Treatment completion is a key indicator of success in substance use disorder (SUD) treatment programs, associated with reduced relapse and improved long-term recovery outcomes. While several factors influencing treatment completion have been identified, whether these predictors differ by sex specifically among Veterans in community-based programs remains unknown. To identify predictors of treatment non-completion, we analyzed 2018-2022 Treatment Episode Dataset - Discharges (TEDS-D) data for 168,092 U.S. Veterans discharged from publicly funded community-based SUD treatment programs. Eleven predictors were examined using sex-stratified binary logistic regression models. Predictors included sociodemographic factors (i.e. age, race/ethnicity, educational attainment, employment status, housing status, recent arrests, treatment setting), and treatment-related variables (i.e. co-occurring psychiatric disorders, polysubstance use, prior SUD treatment history, substance use at treatment discharge). All predictors were significantly associated with treatment non-completion; however, only six predictors (i.e. race/ethnicity, employment status, housing status, treatment setting, co-occurring psychiatric disorders, prior SUD treatment history) exhibited sex-dependent patterns. Among females, psychiatric comorbidities, unemployment, unstable housing, and prior SUD treatment showed stronger associations with higher odds of non-completion. Among males, outpatient care was associated with higher odds of treatment non-completion, while Hispanic/Latino males and males of other non-Hispanic race and ethnicity had lower odds of non-completion relative to White non-Hispanic males. Recognizing sex differences in risk factors for SUD treatment non-completion among Veterans receiving community-based care may inform more responsive interventions. Integrating these considerations into treatment approaches may improve retention and support sustained recovery.