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When it comes to the treatment of people with addiction there is a huge discrepancy between those with it and those that actually receive treatment.

In 2016 there were approximately 21 million people 12 years old and older who needed substance abuse treatment. That is about 1 in 13 people in this age group! However, only 3.8 million people actually received treatment who were 12 and older.

There are several reasons that someone might not receive treatment. Sometimes, they are reluctant to seek treatment because there are certain stigmas about it, or it could be a financial reason. A huge problem with seeking treatment is the availability of it.

Even though there are many barriers remaining, some hopeful signs point to treatment becoming more within reach for populations who have previously struggled to find recovery help.

Number of Programs Available

One of the prevalent problems plaguing searchers of treatment is the lack of programs available. Each year, the Substance Abuse and Mental Health Services Administration (SAMHSA) surveys treatment centers across the country. In 2016, SAMHSA reported the following numbers on types of treatment centers available in the United States:

● Residential programs: 3,469 (1,816 short-term, less than 30 days; 2,814 long-term, more than 30 days; 954 detoxification programs)
● Hospital inpatient: 751 (550 treatment, 661 detoxification/withdrawal symptoms)
● Outpatient: 11,836 (11,036 regular outpatient, 6,553 intensive outpatient, 1,890 day treatment/partial hospitalization, 1,361 detoxification programs, 3,079 methadone maintenance)
● Dual diagnosis (treatment of both addiction and mental health disorders): 6,749
Counselors: 12,560 providing substance abuse and behavior disorder treatment

Twelve-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) periodically survey their members. As of January 1, 2018, AA for alcoholism treatment had 61,904 groups and nearly 1.3 million members in the United States. And as of April 2016, Narcotics Anonymous held 67,000 meetings in 139 countries.

Although there are a wide variety of addiction treatment programs and centers available in the US, there is limited space at the centers. Most centers serve a limited number of patients at any given time due to bed availability, staff, and insurance. Unfortunately, the numbers do not tell a good outcome either in regards to the ability of the facilities treating patients. Of the 14,399 facilities surveyed by SAMHSA in 2016 served a little more than 1.1 million patients—far less than the 21 million people age 12 and older who needed treatment that year.

Geographic Limitations

As you research for rehab programs you will see that a large portion of programs in the United States is concentrated in states with high populations. In 2016:
● California had 1,430 treatment facilities.
● New York had 922 facilities.
● Florida had 716 facilities.
● Illinois had 675 facilities.

Conversely, states with low populations tend to have fewer facilities, and many of these states are quite large geographically—which means facilities are more spread out and harder to access for people in rural areas.

In 2016:
● Vermont had 46 treatment facilities
● Wyoming had 58 facilities
● Montana had 64 facilities

RURAL AREAS

People in rural areas face difficult and particular hurdles to find treatment: 92% of the substance abuse treatment facilities in the United States are in urban areas. Rural areas face specific shortages in inpatient and partial hospitalization or day treatment programs since most are centralized in largely populated cities.

However, the lack of treatment options does not stop at centers and programs. 90% of the physicians who are approved to prescribe buprenorphine—a common medication used to treat opioid addiction—practice in urban areas. About 53% of rural counties do not have a physician who can prescribe it, and rural providers who can prescribe buprenorphine report high demand, a lack of resources, and long wait times for patients.

Another problem plaguing rural areas is also less likely to offer some specialty treatment addiction programs, such as those specifically tailored to certain genders or races. Coincidentally, patients in these areas also have a harder time maintaining their anonymity, especially since there are not as many facilities and they may be recognized in a group meeting at another facility.

Financial

All too often, financial limitations are one of the major barriers that prevent people from receiving treatment. Insurance can help cover the cost of substance abuse treatment, but many people remain uninsured due to:

● The high cost of insurance.
● The loss of a job.
● Losing Medicaid (for those who previously qualified).
● Lack of insurance through an employer.
● Change in family status.
● Believing that they don’t need coverage.

In fact, in 2016, 27.6 million people ages 0–64 did not have health insurance. Of that 27.6 million people, about 44% of these people were white, 33% were Hispanic, 15% were black, 5% were Asian/Native Hawaiian or Pacific Islander, and 3% were of another race, and three-quarters of them were in a household with one or more full-time workers.

Socioeconomic status also plays a role in whether someone can access and complete treatment. It has long been established as a risk factor that can prevent people from entering treatment. In fact, one study found that blacks and Hispanics were less likely to complete addiction treatment largely due to differences in socioeconomic status. Some states that were particularly among this demographic is higher unemployment and unstable housing.

COST OF REHAB

Sadly, many people do not enter treatment because they think they can not afford it, which is sometimes true.

The actual cost that someone will pay for rehab depends on a number of factors such as:

● Insurance coverage.
● Length of treatment.
● Type of program (inpatient vs. outpatient).
● Treatment for physical and mental health problems.
● Where the program is located.
● Program amenities (gym, spa, chef-prepared meals, etc.).

The full cost of treatment can range from $15,000 to $27,000, depending on the factors above. Individual treatment option estimates are:

● Professional intervention services: $2,500 plus other expenses.
● Medically supervised detox: $500-$650 per day (private pay rate, no insurance).
● Partial hospitalization: $350-$450 per day (private pay rate).
● Inpatient care: $500-$650 per day (private pay rate).
● Intensive outpatient care: $250-$350 per day (private pay rate).
● Sober living home/halfway house: $1,500-$2,500 per month

Additional Challenges

In addition to the issues outlined above, there are a number of other reasons why people have a hard time getting help for an addiction.

STIGMA

This is a big one, especially in small towns. The stigma around addiction can affect someone’s decision to seek treatment. One study that looked at people’s reasons for not seeking treatment found that:

● 3% of respondents said they would lose friends if they went to treatment.
● 4% said people would think poorly or less of them if they sought treatment.
● 5% said their family would be embarrassed or ashamed of them if they went to treatment.

People also might not get help because they hold personal beliefs about treatment or themselves. The study further found that:

● 5% of respondents stated they did not like to talk in groups.
● 6% said they did not like talking about their lives with other people.
● 5% did not believe they had a problem with drugs.
● 3% said they did not think treatment would make their life better.

WOMEN

Women face several specific barriers to treatment, particularly around pregnancy and childcare. That because many programs do not offer services for pregnant women or childcare, and women may have trouble regularly attending treatment sessions due to family obligations.

Women are also more likely than men to experience economic barriers to treatment. Unfortunately, many have lower levels of education, rates of employment, and income. These risk factors play a part in why women are less likely to seek treatment. In addition, they may have less support from their families or partners to enter treatment and encounter more stigma and discrimination for their addictions.

CO-OCCURRING DISORDERS

Many people with addictions, woefully, will struggle with mental health disorders as well. When someone has a substance abuse problem and a psychiatric issue, it is known as a dual diagnosis or co-occurring disorders. More than 8 million people aged 18 or older, or 3.4% of this population, was considered a dual diagnosis in 2016.

Unfortunately, this population is less likely to enter treatment than others who are not dually diagnosed. Only 7.4% get treatment for both conditions, and 55% do not get treatment at all.
A major barrier for those with a dual diagnosis is a lack of programs that can provide adequate treatment. 18% of substance abuse programs and 9% of mental health programs are equipped to properly treat co-occurring disorders.

It is difficult for this demographic. People with schizophrenia who also have a substance abuse problem may have exacerbated mental health symptoms. This can lower their motivation to seek treatment. Regrettably, people who are minorities or from lower socioeconomic backgrounds may believe that their mental illness or substance abuse adds another layer of stigma to their already marginalized situation.

How to Overcome Obstacles

Overcoming the barriers presented above is challenging. Because they occur on a number of levels: structural, systemic, personal, societal, and socioeconomic, it can be difficult to rise above.

A solution to help overcome the obstacles is looking for the right type of treatment that provides the necessary structure you need.

TYPES

For people who struggle to afford or access the main types of rehab treatment (inpatient, outpatient, individual and group therapy), self-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are free programs available in most cities around the country.

Someone suffering from alcohol use disorder might find solace going to a meeting with other people that have a problem drinking alcohol and need to stop drinking. Dr. Buscema and The National Institute on Alcohol Abuse and Alcoholism can offer recommendations on the treatment of binge drinking, drugs and alcohol problems.

Both NA and AA use a 12-step model that includes working with a sponsor and receiving support from other people in recovery. Meeting times and information can be found on the websites for central offices for your city or by calling the offices directly. These programs have helped overcome issues with alcohol abuse and substance abuse problems.

For people who are not comfortable with the spiritual aspect of 12-step groups, there are a number of non-12-step programs such as SMART Recovery, Secular Organizations for Sobriety, LifeRing Secular Recovery, and Women for Sobriety. These programs promote self-reliance and develop programs based on the latest evidence-based approaches to addiction treatment, such as cognitive-behavioral therapy.

Whichever form of treatment someone decides it can drastically alter their life for the better. Those who consume alcohol in excess can suffer from chronic diseases, especially liver diseases.

What Else Can You Do?

Learning as much as you can about drug and alcohol abuse, addiction and co-occurring mental health issues, will help you understand more about what treatment is right for you or your loved one. Find a support group or person that can help you navigate your course of treatment. Dr. Charles Buscema at Addiction Alternatives can also assist in navigating the course of recovery.

Dr. Charles Buscema is there to help during the road to recovery. Offering a variety of services to ensure there is the right treatment for you and your loved ones. Reach out today to see how Addiction Alternatives is the best place to start your journey.