Denial Is the Top Reason Substance Abusers Go Untreated

Denial Is the Top Reason Substance Abusers Go UntreatedIt’s no secret that many people with addictions can go years untreated because they deny they’ve got a problem, but now there are numbers to back it up. About 1 in 12 Americans are in need of substance abuse treatment, new research says, but only a fraction of people are getting it. Failure among substance abusers to recognize they need treatment is the overwhelming reason they don’t get help.

And that denial, along with lack of funds as a close second, is costing the U.S. economy, according to a wide-ranging joint study by the Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation. In the study, called “Substance Use Disorders and the Role of the States,” researchers looked at amount of funds spent by state substance abuse agencies in the 50 states and the District of Columbia between fiscal years 2007 to 2013.

Substance Abuse in Numbers

Although it was found that the United States spent $24 billion toward treating substance abuse (with 69 percent of that amount being publicly funded), the indirect costs are estimated to be many times that. The study cited National Institute of Drug Abuse figures that put the yearly cost at $700 billion for factors that include health care, lost productivity at work and criminal behavior.

The greatest of these costs was for the health care costs of tobacco at $130 billion. Addiction to tobacco also led in overall costs at $295 billion, followed by alcohol abuse at $224 billion and illicit drugs at $193 billion.

But despite the billions being spent on treatment, less than 1 in 5 (18 percent) of those above the age of 12 who needed to address their abuse of alcohol or illicit drugs received care in 2013, the most recent year such figures were available. About 19 of every 20 of those requiring treatment (96 percent) didn’t get it because they didn’t think they needed it.

Acknowledging But Ignoring Substance Abuse Treatment

Even among those who felt that they needed treatment, less than a third (30 percent) made an effort to get it. Lack of health insurance coverage and the inability to pay the cost were most often given as the reasons treatment wasn’t obtained.

The illicit drugs determined to be most prevalent in 2013 — and used at least monthly by about 1 in 10 of the over-12 population (9.4 percent) — were marijuana, pain relievers and tranquilizers, and cocaine. And about 1 in 16 in that demographic had at least five drinks at least five times per month (so-called “heavy drinking”), some of whom also used illicit drugs. The 18- to 25-year olds surveyed were the most likely age group to use illicit drugs and/or drink heavily.

Other Key Substance Abuse Insights

The Pew study revealed additional information about substance abuse and barriers to addiction treatment:

  • Most of those who got treatment obtained it at self-help groups, drug or alcohol rehabilitation facilities, mental health centers, or hospitals, with the remainder accessing it in doctor’s offices, emergency rooms or the criminal justice system.
  • More than half of the adults with a substance use disorder were employed full time, but in 2012, employed persons made up only 22 percent of those admitted to facilities, both public and private, that received public funding.
  • About 8 million children in the U.S. live with a parent who has a substance use disorder, which puts them at greater risk of being in need of child protective services. Substance abuse by parents is estimated to be a factor in at least one-third and possibly as many as two-thirds of child protective services cases.
  • About 65 percent of adults imprisoned or jailed in America in 2010 could be defined as having a substance use disorder, a rate seven times that of the rest of the adult population. Those adults 18 and over were four times as likely to be substance abusers.
  • State and local governments in 2009 picked up about a third ($7.6 billion) of the cost of treating substance abuse, not counting another $1.8 billion in Medicaid payments.
  • The last three decades has seen a shift from inpatient care to a combination of outpatient and residential treatment, as well as a dramatic increase in prescription drugs to treat opioid addiction.
  • In 2012 and 2013, the rate of substance use disorders ranged from 7.1 percent of residents aged 12 or older in Utah to 13.8 percent in the District of Columbia.

Denial is a tough hurdle in getting the help a substance-dependent person needs, and it’s often the high-functioning user who pulls off their addiction the longest.

“Because they don’t fit the stereotype, high-functioning addicts can spend years, even decades, in denial,” said David Sack, MD, a national treatment expert and CEO of Elements Behavioral Health. “Even if they acknowledge that they drink or use drugs more than they should, they may feel entitled to indulge as a reward for their hard work.”

By Nancy Wride

Follow Nancy on Twitter at @NWride

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