Just How Prevalent is Addiction in the United States?
New findings about who uses treatment in the U.S.
Posted Nov 25, 2019
This post is co-authored by Khary Rigg, Ph.D. and Kim Johnson, Ph.D.
Substance use disorders (SUDs) occur when individuals continue to use alcohol or drugs despite clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. SUDs are a major public health issue in the United States that causes a significant amount of death and economic burden. In 2017, over 70,000 Americans died from a drug overdose, and SUDs are estimated to cost the U.S. government over $740 billion annually in lost work productivity and criminal justice and health care expenses.
Fortunately, SUDs are a treatable condition, and there are several effective medications (e.g., buprenorphine) and behavioral interventions (e.g., cognitive-behavioral therapy) that are available to help people in their recovery. Receiving treatment can help individuals learn healthier coping strategies, address existing traumas, and establish a sober lifestyle. Studies also show that individuals in treatment are less likely to engage in criminal behavior, practice high-risk sexual behaviors, and share injection equipment.
Most importantly, though, treatment can significantly lower the risk of overdose, in some cases by as much as 50 percent. Although there are clear benefits to receiving treatment, the majority of people with a SUD do not get the treatment they need.
A recent study took a closer look at the prevalence of SUDs in the U.S. and the factors that explain treatment utilization. The study revealed some interesting findings that treatment providers and policymakers could benefit from.
Prevalence of Substance Use Disorders in the U.S.
Approximately 10 percent of the population meet DSM-5 diagnostic criteria for having a SUD. Of the people that meet the criteria for having a SUD, 63 percent have a mild disorder, 20 percent have a moderate disorder, and 17.5 percent have a severe disorder. Assuming the U.S. population (over age 12) to be approximately 270 million, then 26.5 million people are estimated to have a SUD, 17 million of whom have a mild SUD, 5 million of whom have a moderate SUD, and 5 million of whom have a severe SUD. The study also found that young adult men have the highest prevalence of SUD (23 percent of men ages 18-25 compared to the overall population rate of 10 percent).
Treatment Receipt in the U.S.
A lot has been made of the so-called “treatment gap” in the U.S. The treatment gap refers to the number of Americans that need but do not receive treatment. Findings show that the SUD treatment gap is sizable in the U.S., with only 10 percent of Americans who need SUD treatment actually receiving it.
One of the study’s more interesting findings was that individuals on probation had a much higher likelihood of receiving treatment than those who were not involved in the criminal justice system. The study found that over 43 percent of people on probation received treatment for their SUD, which means that justice-involved persons are 20 times more likely than those who aren’t to receive the treatment they need.
With regard to income level, interestingly, Americans living below the poverty line were more likely to have received SUD treatment than any other income level. This finding was somewhat surprising, given that people in higher income brackets are usually insured, stably housed, and better educated. Also, Americans with higher incomes tend to live in resource-rich communities where treatment providers are more readily accessible.
The study also found that Americans are unlikely to use treatment at low levels of severity. For example, only 3 percent of Americans with a mild SUD received treatment in the past year, whereas almost 30 percent with severe SUD did. This trend is even more pronounced among Americans struggling with opioid use disorder (OUD), with only 9.3 percent with mild OUD receiving treatment, but over 55 percent with severe OUD in treatment.
What Are the Major Takeaways?
These findings are interesting for a number of reasons. First, they show that Americans are unlikely to use treatment at low levels of severity. The government and clinicians may want to consider how to best address the large population of people with low-severity SUDs.
Primary care or other systems that interact with these individuals may be able to provide harm reduction advice (e.g., reduce quantity/frequency, avoid certain drug combinations, naloxone distribution/training) and monitor for changes in severity as they do for other conditions. This would be more effective than waiting until people have severe symptoms and need a specialty treatment.
Second, the fact that criminal justice involvement seems to be a common pathway to treatment is troubling. This is indeed an indictment of our current health care system because it suggests that for many Americans, being arrested is one of the best ways to receive care. While it’s true that there are people with SUD who refuse or aren’t interested in help, many are desperately seeking treatment, but are met with a myriad of barriers, like long wait lists, lack of bed availability, no available prescribers, or no insurance coverage.
This can be very discouraging for those who are ready to start the recovery process. In fact, there are more than a few stories of people resorting to crime simply to enter treatment. Earlier this year, a woman who couldn’t afford treatment walked into a CVS pharmacy and began shoplifting various items. When the police arrived, she told them that the only reason she resorted to stealing was so that she could go to jail, because she is “addicted to heroin and cannot get help anywhere else.”
This, unfortunately, is not an isolated incident, and people with SUD deserve better. A good place to start is to require insurance companies to cover SUD treatment, increase the number of buprenorphine prescribers by getting rid of the DEA waiver, update federal regulation of methadone maintenance, and increase the number of treatment facilities that accept Medicaid.
As the opioid crisis grinds on and a new crisis of stimulant use is on the horizon, now, more than ever, we need to rethink our treatment model. Patient, family, and medical provider perception of addiction treatment as a mysterious thing that happens in a residential program far away from home persists. Also, the association of addiction with illegal activity is firmly cemented in people’s minds and in the reality of treatment access. Addressing the needs of patients with low-severity SUD in a low-barrier setting may prevent the progression of the disease for some, reduce criminal justice system involvement in managing this health condition for many, and ensure there is access to specialty care for those that really need it.
In short, the better we get at connecting people to treatment, as well as retaining them in care, the faster we can begin to curb the rising tide of overdose deaths.