Many individuals who experience substance use disorders and could benefit from treatment do not receive care.
According to SAMHSA’s National Survey on Drug Use and Health (NSDUH)1, in 2016, an estimated 20.1 million people aged 12 or older had a substance use disorder related to their use of alcohol or illicit drugs in the past year, including 15.1 million people who had an alcohol use disorder and 7.4 million people who had an illicit drug use disorder. Though an estimated 21 million people aged 12 or older needed treatment for a substance use disorder in 2016, however, only 1.4% of them received any such treatment (3.8 million).
In other words: in 2016, 17.2 million Americans who needed treatment didn't receive it.
According to the NSDUH 2016 report, the two most common reasons for not receiving substance use treatment among adults age 18 or older who needed treatment but did not receive it, were:
Similarly, among all adults and among adults with any mental illness or among those with severe mental illness who perceived a need for mental health services but did not receive them, inability to afford the cost of care was the most commonly reported reason for not receiving services.
Removing Barriers Improves Retention
Providers in Washington State surveyed as part of the 2017 Behavioral Health Provider Survey noted a range of approaches used to improve retention both in treatment and during client transition to another level of care.
The most common ways providers try to improve retention outcomes are featured in the infographic on the right (view a larger version here). In addition to those 8 techniques, providers also reported using co-location of other services (27%), participation incentives/contingency management for clients (22%), use of child and family teams (20%), linking clients with a sponsor (12%), and on-site child care (6%).
The most common approaches Washington providers use to achieve client transition to another level of care are:
Some Advice from NIATx
Two success stories (from NIATx)
The Partnership for Advancing Recovery in Kentucky installed webcams in agencies that worked together so that clients would meet a counselor in the outpatient program before leaving residential treatment. They also arranged for doctors to use video conferencing to meet with clients who lived in rural areas. For more informationa bout this change and all of the changes implemented by PARK, see the PARK Continuum of Care.
The Center for Human Services in Seattle, WA decreased no-show rates from 80% to 65% and increased admissions by 87% by performing assessments at the Community Service Office (the referrer) one day a week instead of requiring all assessments be done at their facility. For more information, see the CHS story (on the NIATx site).
NIATx Resources on Eliminating Barriers to Treatment
Includes stories about successful implementation at real treatment agencies, lessons learned, tracking measures, action steps, and more.
Community Health Centers and First Responders: Strengthening Communities through Education
This Recovery Month webcast, which launched on June 7, 2017, will address the behavioral health needs relevant for rural and frontier communities, share innovative approaches to addressing them in remote areas, and review the challenges faced when attempting to reduce the treatment gap for rural and frontier residents. It will also address the special considerations of Native American/American Indian communities living in rural areas.
Recovery Among Diverse Populations
Recovery Month Webcast, September 2017, Explores best practices and methods for overcoming barriers to connect clients with culturally responsive treatment and recovery services.
TAP 33: Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Substance Abuse and Mental Health Services Administration (SAMHSA) Technical Assistance Publication Series, May 2013, about SBIRT services implementation, covering challenges, barriers, cost, and sustainability.
NAADAC Webinar: Improving Retention and Outcomes: The Partners for Change Outcome Management System (2015)
Learn what is being used effectively with clients across behavioral health diagnostic categories and in public and private service delivery systems resulting in significantly reduced dropouts and improved recovery outcomes.
Webinar: Treatment 101: Finding Effective Care NEW!
Recovery Month Webcast, April 2018, Panelists also address the barriers to quality care, treatment of co-occurring disorders, and the role behavioral health counselors can play in primary care settings.
References & Readings