Of those whose addiction involves nicotine, the
only data available are for persons ages 18 and
older who have tried to quit smoking; less than
one-third (31.7 percent) of these individuals*
receive smoking cessation services.† 2
A key factor contributing to the treatment gap is
the way treatment costs are covered. In contrast
to the role of private insurance in medical care
spending--where it covers 55.6 percent of
costs, private insurers cover only 20.8 percent of
the costs of addiction treatment, and the private
share has been decreasing. Instead, public
spending accounts for 79.2 percent of the costs
of addiction treatment in the United States.^3
This skewing of services to populations
dependent on public resources is in part a result
of our failure to prevent and treat this disease.
Public spending also has concentrated available
resources for treatment in non-residential
services operated outside of the mainstream
health care system. In both public and private
plans, insurance coverage for addiction care has
been limited in the range of covered services.^4
National data indicate that people in need of
help for addiction largely choose to turn to a
health professional; however, only 5.7 percent of
referrals to addiction treatment come from
health professionals. The largest share of
referrals--44.3 percent--comes from the criminal
justice system,^5 demonstrating our nation’s
attention to the social consequences of addiction
rather than to prevention and treatment of the
disease. Even those who are referred to
treatment may face long waits for admission and
the longer the wait the less likely patients are to
enter or complete treatment.^6
Only 42.1 percent of those receiving treatment
for addiction involving alcohol or drugs other
than nicotine complete their course of care.^7
The highest treatment completion rates are from
venues to which there are the least referrals--
residential treatment; the lowest treatment
- Among current smokers who tried to quit in the past
year and former smokers who successfully quit in the
past two years.
† In the form of counseling or smoking cessation
medications.
completion rates are from venues to which there
are the most referrals--non-residential
treatment.^8A range of factors contribute to these spending,
referral and service delivery patterns that
account for the treatment gap, including a
misunderstanding of the disease of addiction, a
lack of appropriate disease staging and treatment
services,‡ negative public attitudes and behavior
toward those with the disease, privacy concerns,
cost, lack of information on how to get help,
limited availability of services including a lack
of trained addiction physician specialists,
insufficient social support, conflicting time
commitments, negative perceptions of the
treatment process and legal barriers. Certain
populations with addiction, including those with
co-occurring health conditions, pregnant and
parenting women, adolescents, older adults, the
homeless, veterans and those in active duty
military, individuals living in rural areas and
Native Americans, face additional barriers.This chapter examines the disconnect between
those in need of treatment and those who receive
it. The fact that those who do receive some form
of treatment rarely receive quality, evidence-
based care is discussed in Chapter X.‡ See Chapter X.