Each year millions of people who need treatment for an alcohol or drug abuse or dependency do not receive it.
The National Survey on Drug Use and Health (NSDUH), published in 2013, approximated that 22.7 million Americans aged 12 and older needed specialized treatment for an alcohol or illicit drug abuse issue. Only 10.9 percent, or 2.5 million, of those needing treatment actually received it in a specialized facility, leaving 20.2 million people without the proper treatment they needed.
Many barriers exist that prevent those who need treatment from seeking or receiving the required care. The Substance Abuse and Mental Health Services Administration (SAMHSA), which publishes the NSDUH report, used combined data from 2010-2013 to attempt to discover why the disparity exists. Those who recognized that they needed treatment gave the following reasons for not receiving it:
- Not prepared to stop using: 40.3 percent
- No health coverage and financial difficulties covering the cost of care: 31.4 percent
- Potential implications in the workplace: 10.7 percent
- Possible negative perceptions by friends, neighbors and/or the community: 10.1 percent
- Unsure where to obtain treatment: 9.2 percent
- Programs not having type of treatment needed: 8 percent
Of those struggling with substance abuse who perceived the need for treatment and actively sought it out, additional or different obstacles existed as well. Treatment was still not received after making an effort to obtain it for the following reasons:
- Cost-prohibitive or no health coverage: 37.3 percent
- Not ready to abstain from using: 24.5 percent
- Unsure where to obtain treatment: 9 percent
- Health insurance did not cover costs or treatment: 8.2 percent
- Treatment was inconvenient or no transportation was available: 8 percent
Addiction is a chronic brain disease that requires specialized treatment in order to maintain successful recovery. Regardless of your individual circumstances, you can overcome these barriers and receive the right treatment to help you reach your goals for a healthy and more balanced life.
Motivation
Recognition that a problem exists may be the first obstacle standing in the way of sobriety. Denial, or the idea that treatment is either unnecessary or ineffectual, may be an internal barrier preventing substance abusers from seeking help. Addicts spend excessive amounts of time obtaining, abusing, and recovering from their substance of choice. They may pull away from friends and family members, stop engaging in activities they used to enjoy, and be less productive with work, family and school obligations.
Chronic drug or alcohol abuse makes chemical changes in the reward pathways of the brain, interfering with the natural motivation system. In short, abusing substances may numb emotions and pain sensations and increase happy feelings for a time. When the drug is removed, however, withdrawal symptoms may occur, leaving addicts feeling depressed, agitated, irritable and even physically ill. The brain has likely developed a physical and psychological attachment or dependence to the substance, and addicts are not often keen to break this bond.
If an addict is unable to find the initial internal drive to seek treatment, assistance may be necessary. Families and loved ones may use the services of an interventionist in order to help a loved one recognize the need to enter a treatment program.
The idea that an addict must first hit rock bottom, or make the choice to seek out treatment on their own, is not entirely correct. Often, it takes the help of an outside motivator in order to realize that treatment is necessary; however, this does not detract from the efficacy of treatment once received. Outside influences that push substance users toward treatment can come in the form of a health concern, deterioration of family and interpersonal relationships, loss of a job, or even legal troubles.
The National Institute on Drug Abuse (NIDA) estimates that court-mandated treatment or legal pressure may actually increase retention rates and successful outcomes. Once in treatment, either mandatory, coerced, or voluntary, substance abusers often find the internal motivation necessary to continue and make a successful recovery.
Finances and/or Insurance Issues
Substance abuse treatment is not generally free, and it is often perceived as cost-prohibitive. Many times, this is a misconception, as more and more health insurance companies and policies cover at least some form of substance abuse treatment. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires insurance issuers and group health plans to provide coverage for substance abuse disorders in much the same manner that they cover surgical or other medical procedures. Treatment or visits should not be limited, or deductibles or co-pays financially inaccessible under the MHPAEA.
President Obama’s Affordable Care Act (ACA) also makes health insurance more accessible to more people and includes substance abuse treatment as one of the essential benefits under the 10 elements of health care coverage. As of January 1, 2014, all health insurance coverage must include substance abuse treatment, as reported by CBS New York. You may not be denied coverage for a preexisting substance abuse issue, and substance abuse screening is now considered preventative care and must be covered under the ACA.
Health insurance plans will vary in the type of treatment covered, however, so be sure to check your coverage carefully to determine what is covered and what the requirements may be. Some may require a referral from your primary care doctor, while others may expect you to enter into an outpatient treatment program and be unsuccessful before covering a residential program, for example.
Most states, cities or counties also provide free and publically funded substance abuse treatment for those who cannot afford health insurance or who are covered under Medicaid. Self-help and 12-Step support groups are also generally free of charge and an important part of the recovery process. Some treatment facilities may offer various payment methods as well, including payment on a sliding scale or scholarships based on eligibility requirements.
Even though drug or alcohol treatment may be expensive, it may actually save you money over the course of time. Addiction is a financial burden in itself, costing addicts money to continue, money in health care issues related to the substance abuse, potential loss of funds due to a lack of workplace production, and even financial burdens due to legal actions resulting from substance abuse. Addiction may cost you up to seven times more than the cost of a successful treatment program in the long run, as reported by Everyday Health. Seeking treatment may actually be more cost-effective, therefore, than not receiving the proper care.
Finding the right treatment is an important component to ensuring long-term recovery and lessening the severity and frequency of relapse. All too often, someone who struggles with substance abuse or dependency will also have a mental health disorder that may be either undiagnosed or untreated. The National Alliance on Mental Illness (NAMI) approximates that as many as 53 percent of drug abusers and 37 percent of alcohol abusers also suffer from at least one serious mental illness. It may be unclear which disorder came first, as substance abuse can exacerbate or initiate mental illness symptoms, while those suffering from a mental illness may seek to abuse drugs or alcohol as a method of self-medication.
When a mental health disorder and a substance use disorder are present in the same person at the same time, the disorders are said to be co-occurring. Unfortunately, the Journal of the American Medical Association (JAMA) reports that less than half of those suffering from co-occurring disorders received any form of treatment for either disorder, while one-third received treatment for their mental health disorder only, two percent for their substance abuse disorder only, and a mere 12 percent received treatment for both disorders.
Integrated treatment has been shown to offer the highest success rates for both disorders. This treatment model, often called dual diagnosis treatment, treats each disorder as a primary disorder and manages both simultaneously. Teams of medical professionals work together, using evidence-based methods, in order to promote successful management and decrease of symptoms. Specialized facilities that offer dual diagnosis care are beginning to become more common and accessible.
Addiction is considered a disease. Although addicts are often hesitant to seek treatment due to negative connotations or perceptions they feel may potentially arise from admitting to a substance abuse disorder, it is important to realize that all diseases require treatment in order for recovery to take place. Relapse is a common part of the disease of addiction, and relapse rates are similar to those seen with other chronic diseases, such as type 1 diabetes, hypertension, and asthma at between 40 and 60 percent, according to NIDA. Recognizing the similarity between addiction and other chronic diseases may help to dispel some of the potential negative perceptions surrounding substance abuse disorders.Addiction is a treatable disease and does not have to be a life sentence. Understanding that substance abuse is common and as many as 10 percent of Americans aged 18 and older consider themselves to be in recovery from a substance abuse issue, according to a survey done by the New York State Office of Alcoholism and Substance Abuse Services (OASAS), may also help you to realize that you are not alone. Support groups and 12-Step programs exist to provide peer networks of individuals facing similar circumstances as well.Another potential obstacle to obtaining treatment may be the concern of not being able to meet work, family or school obligations while in rehab. Successful treatment programs come in many forms, however. Residential treatment is an option for those who can afford to set other obligations on hold for long enough to regain balance and learn coping mechanisms through comprehensive therapy, counseling and educational sessions before returning home. The duration of substance abuse treatment depends on many factors, including the severity of the addiction, duration of substance abuse as well as other genetic and environmental factors.
Sometimes a medical detox protocol is necessary in order to safely regain physical balance while removing toxins from the body. This process utilizes medications to stabilize individuals in a secure environment staffed by medical professionals around the clock. Outpatient treatment programs exist as well and may work best for those with a strong support system at home and outside obligations that cannot be placed on hold.
Finding a treatment program that is convenient to you and attends to your unique preferences is important as well. Many specialized facilities exist to attend to specific cultural, gender, religious, sexual orientation and mental health status parameters, making treatment more accessible to more people.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton