intensive outpatient (25.9 percent vs. 15.1
percent),
short-term residential (21.6 percent vs. 14.1
percent), and
longer-term residential (7.6 percent vs. 3.0
percent).^83
Privately-funded admissions are likelier than
publicly-funded admissions to be to non-
intensive outpatient services (67.6 percent vs.
44.7 percent), have a higher rate of treatment
completion (53.7 percent vs. 42.9 percent) and
have a lower rate of transfer to another facility
(12.2 percent vs. 17.9 percent).^84
Existing data do not provide an explanation for
these differences and no data are available on
treatment needs and outcomes by funding source
and type of service provided. Possible
contributing factors, however, might include that
privately-funded admissions are likelier to
involve less severe cases of addiction, those with
private resources may have greater access to
effective support services or quality care, or
those with private insurance may be less likely
to seek treatment perhaps due to the perceived
stigma.^85
Barriers Patients Face in Accessing and Completing Addiction Treatment ....................
In addition to the limited private sector coverage
of addiction treatment and the lack of treatment
referrals from the health care system, many
other barriers stand in the way of individuals
accessing and completing addiction treatment.
These include: a misunderstanding of the
disease, 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 physicians trained in addiction care,
insufficient social support, conflicting time
commitments, negative perceptions of the
treatment process and legal barriers. Other
factors having to do with treatment quality are
discussed in Chapter X. Rarely is there only one
obstacle to a person receiving needed
treatment.^86Although comparable national data for barriers
to accessing smoking cessation treatment are not
available, research indicates that barriers similar
to those facing individuals seeking addiction
treatment involving alcohol or other drugs stand
in the way of smokers accessing tobacco
cessation services.^87Misunderstanding of the Disease ...............................................................................
One of the most frequently reported barriers to
accessing addiction treatment has been described
as patient denial.^88 However, what is commonly
viewed as denial might also be characterized as
a misunderstanding of the disease. As is the
case for seeking treatment for other health
conditions such as diabetes, hypertension or
heart disease,^89 most cases of denial that serve as
barriers to treatment access actually involve
cases in which a person with symptoms of
addiction does not recognize that he or she has a
treatable disease,^90 underestimates the severity
of the disease^91 or does not believe that the
symptoms can be allayed through treatment.^92
Such feelings stem not only from a lack of
public awareness about the true nature of
addiction--that it is a brain disease that can be
treated effectively--but from the disease itself--
one effect of addictive substances on the brain is
that judgment, self-awareness and insight
become impaired.^93 Continuing to misuse
substances despite the associated harms is a
defining symptom of the disease of addiction^94
and in many cases results from the changes that
addictive substances produce in the structure and
function of the areas of the brain that control
judgment, decision making and behavioral
inhibition and control.^95In one survey of people with a history of
addiction in their families, 60 percent cited
denial as the biggest obstacle to getting help for
addiction.^96 The majority (71.7 percent) of
respondents to CASA Columbia’s NABAS think
that a main reason why people with addiction do
not get the help they need is that they refuse to
admit to having a problem or that they do not