As the opioid epidemic continues across the country, advocates on both sides of the aisle agree on a vital solution: treatment. Although funding for recovery resources was a rare area of bipartisan collaboration during 2018 federal budget discussions, implementation has lagged far behind that allocation. Funds have been tragically slow to reach struggling state-level agencies, and the White House has suggested funding should be split between treatment and its tough-on-crime approach. Experts, meanwhile, welcome federal efforts that emphasize treatment but warn far more spending will be required to meet the nation’s needs effectively. If the necessity of treatment resources is beyond debate, disputes regarding methods and money remain.
But what do national data on addiction and its treatment tell us about how we should approach this complex problem? To find out, we dug into the latest National Survey on Drug Use and Health, studying the prevalence of substance use disorders and how Americans seek help. Our findings shed light on some crucial elements of the country’s drug crisis and reveal the vast degree of desperate need. Keep reading to see who needs treatment most across the country, and which obstacles prevent them from achieving recovery.
Seeking Help by Substance
Among heroin users, more than a third had received treatment at a specialized facility within the past year. Among users of fentanyl, the rate was nearly as high. These figures may seem encouraging, but high rates of relapse among those addicted to opioids have led many to advocate for new treatment methodologies, including medication-assisted approaches. A smaller but significant portion of OxyContin and other opioid users had received treatment in the last year as well.
Often, however, chemically similar substances produced very different rates of seeking treatment. Crack cocaine users had one of the highest rates of receiving help, for example, while fewer than 1 in 10 powder cocaine users attended a facility for treatment. Likewise, methamphetamine users sought treatment at much higher rates than those who used other stimulants.
These disparities may reflect the intensity of these substances or the severity of the personal consequences their users face.
Not Ready for Rehab
Among respondents classified as needing treatment for their substance use problem, only 6.6 percent felt they needed treatment for their use of illicit drugs, while 3.1 percent reported needing help with their drinking. When asked why they weren’t actively seeking treatment, the most common answer was quite simple: They weren’t ready to stop. This was particularly true among users of alcohol, of whom more than 40 percent said they were unready to stop using. A lack of insurance was another common catalyst toward delaying needed treatment. Although the Affordable Care Act requires substance use treatment be included in insurance coverage, millions of Americans remain uninsured.
Other common reasons for putting off treatment related to uncertainty or dissatisfaction regarding available treatment options. Although the treatment industry has grown substantially in recent years, quality of care varies significantly, so choosing the right facility can seem daunting.
Others felt they simply could not find the care they deemed appropriate for their needs. This sentiment was especially common among drug users, perhaps because medication-assisted options have only recently become more commonly available.
Yet, those on probation were less likely to have their need for treatment go unmet, suggesting law enforcement interventions are at least somewhat effective in directing those convicted of crimes to get help.
Probation and recovery have a long and complicated history: While courts often demand sobriety as a condition of supervised release agreements, some advocates criticize that practice, arguing relapse is symptomatic of the chronic illness of addiction. Our data suggest a far greater portion of those on probation experience a substance use disorder, relative to the public as a whole.
That said, individuals recently or currently on probation were more likely to use an array of drugs than the public at large. This disparity was most evident for some of the more dangerous drugs included in our analysis, such as opioids, pain relievers, heroin, and meth. Unfortunately, these figures likely reflect high rates of drug dependence among incarcerated Americans. Such statistics have caused many to suggest more comprehensive treatment in jails and prisons, so former drug users can receive help before they are released.
Substance Misuse and Socioeconomic Status
Our data confirm the notion that poverty is a risk factor for substance misuse: Income was inversely correlated with rates of substance use disorder. Interestingly, however, those who earned more than $24,280 were most likely to misuse alcohol, whereas drug use was most common among those who earned that amount or less. Substance misusers making more than $24,280 were slightly less likely to use psychotherapeutics as well.
Although this pattern was also visible on the level of specific substances, some drugs were common among all economic groups. The most prominent example was marijuana: Nearly half of those making $24,280 or more had used cannabis in the past year. Similarly, in each earnings bracket, more than 1 in 5 substance misusers had used opioids.
This finding resonates with research suggesting the opioid epidemic is a distinctly middle-class phenomenon, rather than one concentrated exclusively in poor communities.
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