Barriers to Treatment and Recovery

According to the National Survey on Drug Use and Health (NSDUH), in 2012 there were 23.1 million Americans aged 12 or older who needed treatment for an illicit drug or alcohol use problem (per DSM IV), yet 20.6 million of these individuals did not receive treatment at a specialty facility in that year. Specialty treatment is defined as hospital inpatient, drug or alcohol rehabilitation facilities, or mental health centers. The six most reported reasons for not receiving treatment were a) not ready to stop using (40.4 percent), b) no health coverage and could not afford cost (34 percent), c) possible negative events on the job (12 percent), d) concern that receiving treatment might cause neighbors/community to have a negative opinion (11.6 percent), e) not knowing where to go for treatment (9.1 percent), and f) had health insurance but did not cover treatment or cost (7.9 percent).

Loosely categorized, the most reported barriers were not ready to stop, lack of insurance coverage, fear of stigma, or not knowing where to go for help.

Jump ahead nine years and the data is equally alarming. According to the US Department of Health and Human Services/Substance Abuse and Mental Health Services Administration (DHHS/SAMHSA) in 2021 40.7 million Americans aged 12 or older who had an illicit drug or alcohol use disorder, needed treatment, yet did not receive treatment. The six most reported reasons were a) not being ready to stop using (36.7 percent), b) having no health care and not being able to afford the cost (24.9 percent, c) not knowing where to go for treatment (17.9 percent), d) not finding a program that offered the type of treatment they wanted (15.8 percent), e) thinking they could handle the problem without treatment (15 percent), and f) being concerned that getting treatment might have a negative effect on their job (14.7 percent).

Simply stated, despite all of the money that the US government has poured into treatment and recovery over the last decade, there are more Americans with an SUD who need help, they still cannot afford to get that help, they don’t know where to get the help, and stigma is still a major barrier to entering treatment.

In my next article I will highlight the reasons for optimism.

Sources:

1. Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
2. Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2022.

Mark Lefebvre is a person in long term recovery and serves as Executive Advisor to Pinetree Institute of Eliot, Maine and Portsmouth, New Hampshire.