Who leaves satisfied? Exploring individual factors associated with substance use disorder service satisfaction

INTRODUCTION: Parental substance use disorders (SUD) are common and treatable, with approximately 1 in 4 U.S. children living with at least one parent with a SUD. Although parents frequently engage in services, little is known about how individual characteristics, such as substance use severity and psychopathology, shape service satisfaction, a key indicator of engagement and recovery. Understanding parent perspectives is essential to supporting parents both as caregivers and clients. METHODS: This mixed-methods cross-sectional study examined associations between substance use severity, psychopathology, and self-reported service satisfaction among parents accessing SUD services in the Pacific Northwest. We estimated multilevel models using survey responses from 420 parents across 23 organizations. To complement these analyses, we thematically analyzed open-ended responses from parents with low satisfaction scores to identify unmet needs and priorities for service improvement. RESULTS: Substance use severity was not significantly associated with satisfaction ratings. However, higher levels of psychopathology were associated with lower treatment satisfaction when adjusting for age and household income. This association remained consistent across service settings. Household income was also associated with satisfaction, with differences observed across income categories. Qualitative findings contextualized these results: parents attributed dissatisfaction to rigid compliance policies, stigmatizing staff interactions, and a lack of family-centered supports such as childcare, flexible scheduling, and housing assistance. CONCLUSIONS: These findings highlight the potential importance of addressing psychopathology in SUD services to improve service satisfaction. Centering parent perspectives may help providers develop more responsive and family-centered services for this important subpopulation of clients.