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Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment: Age 18 and Older

DOMAIN: Behavioral Health

Treatment for alcohol and other drug (AOD) abuse or dependence can improve health, productivity, and social outcomes. It can also save millions of dollars on health care and related costs.

Recommended care for individuals with a new episode of AOD abuse or dependence includes initiating treatment within 14 days of diagnosis (initiation rate) and then continued treatment with two or more additional AOD services or medication treatment within 34 days of the initiation visit (engagement rate).

Explore the percentage of adults with a new episode of AOD abuse or dependence who initiated timely treatment and continued engagement with treatment services in each state. This measure reports the treatment initiation and engagement rates among beneficiaries with the following diagnoses:

  • Total AOD Abuse or Dependence
  • Alcohol Abuse or Dependence
  • Opioid Abuse or Dependence
  • Other Drug Abuse or Dependence

Higher rates are better on this measure.

The purple dashed line represents the median, or middle, of all values reported.

This measure reports state performance on the percentage of adults age 18 and older with a new episode of AOD abuse or dependence who (1) initiated timely treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth, or medication treatment within 14 days of the diagnosis (initiation rate) and (2) initiated treatment and were engaged in ongoing AOD treatment within 34 days of the initial visit (engagement rate).

States voluntarily report on Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications.

The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states.

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Initiation & Engagement of Alcohol & Other Drug Dependence Treatment (IET-AD) measure, visit Adult Health Care Quality Measures.


The following states did not report either the Initiation or Engagement rate for any diagnosis cohorts: AK, AR, CO, DC, ID, ME, MT, NE, NJ, PR, UT, and WY.

The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. This measure is also specified for calculation using electronic health records.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. The following state used NCQA 2019 specifications: OR.  
  • Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments.
  • The measurement period for this measure was January 2019 to November 2019. AZ and KY reported data for FFY 2019.
  • Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (30 states) or age 18 and older (10 states).

ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care.