screened positive for a possible addiction
involving alcohol.* However, of those who
screened positive for risky alcohol use, only
31 percent were advised in the past year to
drink less or stop drinking; 41 percent of
those with a possible addiction involving
alcohol were given such advice.^42 Another
study found that 11.8 percent of soldiers
who returned from Iraq reported risky
alcohol use but only 0.2 percent were
referred to treatment and only 21.6 percent
of those who were referred were seen within
90 days.^43 And although the Handbook on
Uniform Mental Health Services requires
access to opioid maintenance therapy, fewer
than one in five veterans diagnosed with
addiction involving opioids receive this kind
of therapy on an ongoing basis.^44Regional Variations in the Treatment Gap ................................................................
Current national data on regional differences in
the proportion of individuals in need of
addiction treatment are not available.† However,
other research indicates that the disparity
between the number of people who need
addiction treatment and the number who receive
it varies substantially among states and regions
of the country,^45 with southern and southwestern
states having the largest estimated treatment
gaps in the nation and the northeast having the
smallest estimated treatment gap.^46
Although reasons for these geographical
differences in the treatment gap are not well
understood,^47 possible explanations include
variations among states in funding of treatment
services, including differences in coverage of the
costs of these services in state managed care
systems.^48 One study found that only 21 percent
of the variation among states in the percent who
receive treatment was associated with variations
- Based on scores on a version of the AUDIT
instrument (see Appendix H). Risky drinking was
defined as an AUDIT-C score of four or higher for
men and three or higher for women. Addiction was
defined as an AUDIT-C score of four or higher for
women and six or higher for men.
† Public access NSDUH files have not contained
geographic variables since 1998.
in the prevalence of addiction; the rest of the
variation is attributable to these other factors.^49Sources of Funding for Addiction Treatment ..................................................................
Spending on addiction treatment totaled an
estimated $28.0 billion in 2010. Whereas
private payers (including private insurers and
self-payers) are responsible for 55.6 percent
($1.4 trillion) of medical expenditures in the
U.S., they are responsible for only 20.8 percent
($5.8 billion) of addiction treatment spending.^50Public payers picked up the tab for 79.2 percent
($22.2 billion) of expenses for addiction
treatment, with state and local governments
paying for 44.8 percent ($12.6 billion) and the
federal government paying for 34.4 percent
($9.6 billion).^51 (Figures 7.C)The concentration of spending for addiction
treatment in public programs suggests that
insurance across the board does not adequately
cover costs of intervention and treatment, with
costly health and social consequences falling to
government programs. National data‡ indicate
that those with private insurance are three to six
times less likely than those with public insurance
to receive specialty addiction treatment.§ 52‡ From a study examining data from the 2002–2007
editions of the NSDUH. It is not possible to
determine from these data why treatment access
differed based on insurance type since the study
could not take into account important factors such as
individual characteristics and circumstances that may
relate both to type of insurance and likelihood of
treatment access (e.g., symptom severity, SES).
§ Defined in the study as treatment received in
hospital inpatient units, outpatient and residential
addiction treatment facilities, mental health facilities
and methadone maintenance facilities. Services
provided by private physicians (including
psychiatrists), independent practice mental health
practitioners, clergy, in prisons/jails and by self-help
groups are not included in the definition of treatment.
Those with no insurance are almost twice as likely as
those with private insurance to receive specialty
treatment.