Peering Behind The Addiction Treatment Gap

Attend a few presentations about Substance Use Disorders, and odds are you will hear about “the treatment gap,” the gap between the number of people who have an alcohol or drug use disorder and the number who get treatment. Only 10% of people with addiction get treatment. You will hear this fact present in the context of discussions about the lack of access to addiction treatment. You will also hear of the impact of lack of treatment on individuals, families, and communities. What you will not hear is the main reason for the treatment gap – lack of treatment-seeking.

Treatment Seeking for Addiction
	In Year 1 of Illness	Lifetime
Drug dependence	13%	90%
Alcohol dependence	5%	60%
Drug abuse	2%	54%
Alcohol abuse	1%	16%

[Source: Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug Alcohol Depend. 2015 Apr 1; 149: 136–144.]

Treatment seeking is greatest and rises the most sharply over time for those with drug dependence and is the lowest and rises the most slowly for those with alcohol abuse. Thus, dependence and abuse diagnoses essentially reflect greater and lesser severity, respectively, of the disease of addiction.

The study from which the above data is taken found many factors that influence treatment-seeking. For example, it found that a later age of onset of the illness, having never been married and receiving less than a college education, increased the probability of treatment-seeking for alcohol abuse and dependence, but not for drug abuse or dependence.

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health (2016; p. 163) notes that the primary reason for not seeking treatment, applying to almost 41% of people with addictions, is that they are not ready to stop using. About 31% identify insurance coverage as the problem. In comparison, 16% avoid seeking treatment due to concerns about an adverse effect on their job, and 8% do so due to fears of negative opinions of neighbors/community. The 41% who are not ready to stop using may not think they have a problem.

Another study of those referred to treatment found that only 62% of individuals with drug abuse followed through with treatment referral. In that study, the type of drug used, years of use, age, gender, race/ethnicity, and education did not affect treatment entry.  However, those with more severe drug problems, more severe psychological distress, and more severe family problems were less likely to enter treatment. It seems that the individuals who most need treatment are the least likely to go to therapy. Legal pressure improved the odds of entering treatment.

The treatment gap is real. What these studies highlight, nevertheless, is that the treatment gap is not entirely explained by lack of access but also by individuals not thinking they have a problem and those having a problem not being ready for change. These additional factors are important to attend to because just increasing the number of addiction treatment centers will not erase the gap. Building more capacity won’t mean they (the patients) will come. So, yes, we have to increase capacity. But this must be complemented by effective strategies to help individuals with addiction realize the relationship between addiction and their problems and by widespread training of healthcare professionals in helping improve and sustain patients’ readiness for change.