The association of cultural competency practices and wait time to treatment, retention in treatment and completion of treatment in a national sample of opioid treatment programs

Treatment retention and completion are related but distinct indicators of quality in opioid use disorder (OUD) treatment. Less is known about whether organizational cultural competence within opioid treatment programs (OTPs) is associated with wait time to treatment, retention, or completion at the program level. We analyzed cross-sectional data from 150 (OTPs) in the 2023 National Drug Abuse Treatment Survey. Overall cultural competence scores from the Cultural Competency Organizational Assessment-360 were evaluated separately for clinical supervisors and treatment counselors. Complete-case linear regression models examined 12 program-level wait-time, early-engagement, completion, and treatment-duration outcomes; robust standard errors were clustered by the OTP. Holm’s procedure controlled the family-wise error rate across the primary family of 24 cultural-competence tests. Clinical supervisor-rated cultural competence was positively associated with the reported percentage successfully completing treatment among clients who ended treatment ( n = 55; β = 63.59, robust standard error = 18.16, raw p = 0.001; Holm-adjusted p = 0.025). The counselor-rated completion association and two supervisor-rated methadone-duration associations were nominally significant but did not remain significant after the Holm adjustment. No wait-time or early-engagement association survived family-wise error correction. Evidence after multiplicity adjustment was limited to one association with a program-reported, discharge-based completion measure. Because that measure excludes clients who remained in maintenance treatment and the data were cross-sectional, it should not be interpreted as an overall program success rate or as causal evidence. Longitudinal client-level research should distinguish continued retention, dropout, transfer, and planned completion. Not applicable.