Understanding the “Revolving Door” in a Community Substance Use Service: Gender Differences in Readmission
TL;DR
The limited predictors identified for women suggest that routine clinical assessments may overlook important social and structural vulnerabilities and highlight the need for gender-sensitive approaches that account for distinct emotional and cognitive pathways and the service needs of men and women.
Abstract
Background: Access to substance use disorder (SUD) treatment remains a concern in Brazil, particularly among socioeconomically disadvantaged populations affected by cocaine and crack-cocaine use. Community-based services such as the HUB de Cuidados em Crack e Outras Drogas (HUB) in São Paulo aim to engage vulnerable individuals but often face a “revolving door” pattern of repeated admissions. Evidence on predictors of readmission in community-based support services, particularly gender differences, remains limited. This study examines gender-specific predictors of readmission to the HUB within 12 months and changes in clinical characteristics over time. Methods: This is a retrospective observational design study. Records from all individuals who sought treatment for their alcohol and/or drug use in HUB between June 2024–2025 were analysed (number of records = 13,645; number of service users = 6528). This timeframe refers to the study period during which data were collected. Results: Among 6528 service users, most were men (92.6%), with higher readmission rates than women (53.4% vs. 38.6%). Homelessness and synthetic cannabinoid use predicted readmission for both genders. Among men, younger age, substance use patterns, and greater clinical severity were associated with readmission. Among women, recent crack-cocaine use was linked to lower readmission. Over time, men showed worsening substance use and clinical indicators, while women showed reduced stimulant use but increased psychotic symptoms and help-seeking. Conclusions: The “revolving door” pattern of repeatedly entering and leaving services without continuity of care is common in community-based support services like HUB. Risk profiles differ between men and women. The limited predictors identified for women suggest that routine clinical assessments may overlook important social and structural vulnerabilities. These findings highlight the need for gender-sensitive approaches that account for distinct emotional and cognitive pathways and the service needs of men and women.