| The National Survey on Drug Use and Health (NSDUH) is an annual cross-sectional survey of noninstitutionalized
Americans.
We focused our analysis on people in the NSDUH who reported past-year symptoms of an SUD, such as significant impairment related to the use of drugs or alcohol.
Disappointingly, we find that use of SUD treatment in this population did not significantly improve over the decade.
The lack of progress was broad—use of treatment was largely flat when we looked across racial/ethnic groups, income groups, and types of substance use disorder.
The lone bright spot is that we did find slightly increased use of treatment over the decade among people who had been in contact with the criminal legal system.
By contrast, when we examined the population with SUD we found that they were making progress in other overall metrics of health care access.
For example, there was a substantial decrease in the uninsured rate among people with SUD, largely due to increased Medicaid enrollment. More people with SUD were receiving care in a doctor’s office or clinic.
Among those who did get SUD treatment, they were more likely to report that this treatment was covered by their health insurance rather than relying on either a safety-net program or their own out-of-pocket payment.
Our main takeaway from this study is that increasing utilization of SUD treatment is a persistent and unresolved challenge.
While the past
decade brought better insurance coverage and access to care overall for people with SUD, it did not fundamentally change the probability that they would receive treatment—whether in a specialty clinic, an inpatient rehab, or a doctor’s office.
What is needed to meaningfully close the gap in use of treatment?
While our study cannot answer these questions, several ideas are worth considering:
Creating more “on-ramps” to treatment: Our treatment system remains difficult to navigate, especially for people in crisis. A key ingredient in expanding treatment is ensuring that there are points of referral whether they be in
primary care, hospital emergency departments, or jails.
Investing in the workforce: There are not enough addiction specialists to meet the current need. Expanding the workforce requires steps such as increasing the number of advanced practice providers and physicians to treat opioid use disorder with medication, training more counselors, and expanding the number of peer-recovery specialists.
Reducing stigma: While the opioid crisis has created more public awareness of addiction, there remains profound stigma against people with SUDs, which can reduce their willingness to seek help. Public campaigns to celebrate recovery and promote more effective treatment
may be helpful in reducing stigma.
The past decade created some of the building blocks for a better SUD treatment system, but the promise of better access to care remains largely unfulfilled.
Using the existing financing and organizational framework to build a patient-centered system of SUD care remains a critical challenge for the future.
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