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Why Some Have Less Access to Addiction Treatment

Medically Reviewed by Carmelita Swiner, MD on April 21, 2022

If you have trouble controlling your use of alcohol, opioids, cocaine, or any other addictive substance, you’re not alone. Substance use disorder (SUD), or addiction, is a long-term mental health condition that affects your brain chemistry and behavior. More than 21 million Americans have at least one addiction.

While there’s no cure, you can treat and manage addiction. But not everyone who needs help can easily get it. Only about 10% of those with an addiction of some sort get treatment. Part of the reason for that is the many barriers to accessing substance use treatment in the United States.

What Are Common Barriers to Treatment?

The barriers to finding and getting proper substance use treatment vary from person to person. But structural issues such as cost, transport, access to quality care, as well as systemic issues such as racial and ethnic discrimination, might pose challenges for you.

Common barriers to treatment include:

Cost of rehabilitation and treatment. Treatment for substance use disorder can be expensive. That’s one of the major reasons why many people don’t get the proper care. Depending on the type of treatment you need, it could cost anywhere from $15,000-$27,000. If you have health insurance with good coverage, it may help cover some or most of the costs. If you don’t, the expense can be overwhelming.

Your actual treatment costs depend on many factors, such as:

  • Type of insurance coverage
  • Length of stay
  • Type of treatment program, such as whether it includes visits to a clinic or hospital stay
  • Treatment for related physical and mental health issues
  • Program location
  • Amenities at the rehab facility you choose
  • Medication costs

People who are homeless, have substandard housing, or lack employment are likely to find it very difficult to seek help or complete treatment, especially when they can’t meet basic needs.

Geographical limitations. Most substance use treatment and rehab facilities are located in urban areas and in heavily populated states. For example, California has over 2,300 facilities, while Vermont has 62. In fact, you’ll find 92% of addiction centers in big cities.

Large, rural states like Montana, may have treatment facilities in only a handful of locations. This makes it harder to go back and forth for regular care, especially if you live far away.

Not only are there few treatment centers in rural areas, these communities lack licensed substance use specialists who are able to prescribe life-saving drugs. Around 90% of the doctors who can prescribe buprenorphine – a drug commonly used to treat opioid addiction – practice in urban areas. About 53% of rural counties have no doctor who can prescribe this medication, even though there’s a high demand for it.

Some rural areas also lack trained mental health professionals, who can treat substance use disorders. Some 65% of the rural counties in America have no practicing psychiatrist, and 13% lack any behavioral health provider.

Because rural hospitals and addiction care centers tend to have fewer beds, you may have to travel a long way to get care. But rural communities also lack public transport, making treatment more difficult to access.

Stigma. Negative views and judgment around substance use may cause feelings of guilt and shame and affect your decision to get help. One study that looked at reasons why people with SUD didn’t seek help found that some:

  • Worried what friends and family would think if they sought treatment
  • Don’t like to talk in groups or discuss their problems with other
  • Didn’t believe they had a substance use problem
  • Didn’t think treatment would help them

Gender discrimination. There are also gender-based barriers to treatment, especially around the issues of pregnancy and child care. Most substance use treatment facilities don’t offer child care. Further, one study found that some doctors may be less likely to prescribe opioid agonist therapies (OATs) to treat opioid addiction when you’re pregnant. That’s despite the fact that OATs like buprenorphine and methadone are known to be safe and work well during pregnancy.

Another study found that emergency medical service personnel were three times less likely to give naloxone – an emergency drug that reverses the effects of opioid overdose – to women than to men.

Women may also be less likely to get help with addiction due to:

  • Family responsibilities
  • Lower income and lower rates of employment
  • Lack of support from family or partners

Racial and ethnic discrimination. Research has shown that black, indigenous, and people of color (BIPOC) are less likely to get and complete treatment for substance use disorder. Because these differences persist after adjusting for socioeconomic factors, some researchers say this indicates that they’re treated differently.

Among the health care and legal disparities surrounding substance use disorder are these:

  • While SUD rates are similar among BIPOC and white Americans, BIPOC are more likely to face criminal charges because of it.
  • People of color tend to face far worse consequences when they test positive for illegal drug use.
  • People of color are not equally represented in clinical studies for addiction treatment. This can result in culturally inappropriate medical treatment.
  • Black Americans are less likely to be prescribed buprenorphine for opioid use, though they’re more likely to die from overdoses.
  • BIPOC communities are less likely to get preventive medicines and overdose education.
  • Because of cultural norms, Hispanics and Asian Americans may choose informal support from family or community members over medical treatment.

Other mental health issues. Some 3.4% of those with SUD also have another mental health condition. This group is less likely to seek help for their SUD, and just 7.4% of them get treatment for both conditions. One problem is that only 18% of substance use programs are equipped to help you manage other health issues. Many people in the prison population have SUD along with another mental health disorder, and have little access to treatment.

What’s Being Done to Remove the Barriers?

Some government agencies and medical groups are taking steps to deal with barriers to treatment for substance use disorder:

  • The federal Health Resources and Services Administration is working to expand access to telemedicine for addiction treatment in rural or underserved areas. This form of care allows you to virtually connect with a mental health specialist no matter where you live.
  • The Patient Protection and Affordable Care Act (ACA) allows states to expand Medicaid coverage for most low-income adults. This includes everyone under 65 who makes less than $16,643 annually. A total of 38 states and the District of Columbia have opted to expand.
  • The American Society of Addiction Medicine has issued a policy statement asking medical professionals to examine their own motivations and practices during their care for BIPOC. It also calls on these doctors to advocate for policies that ensure equal access to SUD prevention and treatment. And it calls for greater equity in research.

Show Sources

SOURCES:

American Addiction Centers: “Barriers to Addiction Treatment: Why Addicts Don’t Seek Help.”

American Society of Addiction Medicine: “Advancing Racial Justice in Addiction Medicine.”

Association of American Medical Colleges: “21 million Americans suffer from addiction. Just 3,000 physicians are specially trained to treat them.”

Harvard Medical School: “Disparities Seen in Addiction Treatment.”

JAMA Network Open: “Association of Medicaid Expansion With Opioid Overdose Mortality in the United States.”

Massachusetts General Hospital: “Racial-Ethnic Disparities in Substance Use Disorder.”

National Institute of Mental Health: “Substance Use and Co-Occurring Mental Disorders.”

National Institute on Drug Abuse: “Understanding Drug Use and Addiction Drug Facts,” “Access to Addiction Services Differs by Race and Gender.”

Rural Health Information Hub: “Barriers to Preventing and Treating Substance Use Disorders in Rural Communities.”

Substance Abuse: “Barriers to accessing treatment for pregnant women with opioid use disorder in Appalachian states.”

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