Addiction Medicine: Closing the Gap between Science and Practice

Privacy concerns are particularly acute in rural
populations where patients may fear a lack of
anonymity due to relatively smaller and more
close-knit communities.^125

Another element of privacy concerns involves
the aversion of some individuals to key elements
of the therapeutic process--participating in
individual or group therapy where patients
discuss personal or intimate details with
therapists or with other patients.^126 In one study
of individuals with addiction, 36.5 percent of
respondents said they do not like talking in
groups, 35.6 percent said they do not like to talk
about their personal lives with other people and
32.1 percent said they do not like being asked
personal questions.^127 In a study of risky alcohol
users, 50 percent cited a combination of
concerns about privacy, labeling, asking for help
and sharing problems as a reason for not seeking
treatment.^128

Cost*

Cost is one of the most frequently-reported and
long-standing barriers to receiving addiction
treatment.^129 Approximately 50 million
Americans, or 16.3 percent of the United States
population, had no health insurance in 2010.^130
Twenty-nine million insured people are
underinsured† 131 perhaps prompting them to
postpone needed treatment. People who are
uninsured and underinsured not only have higher
rates of chronic, relapsing addiction,^132 but also
generally receive less preventive care, are at
more advanced disease stages at the time of
diagnosis, receive less treatment for health
conditions and have higher mortality rates than
those with comprehensive coverage.^133

A 2009 national survey found that nearly half
(49 percent) of U.S. adults feel that they would
not be able to afford treatment for addiction
involving alcohol or other drugs‡ if they or

• See Chapter VIII for a more complete discussion of

cost-related issues in addiction treatment.
† Those with health insurance, but with very high

medical expenses relative to their incomes.
‡ This survey did not address addiction involving

nicotine.

someone in their family needed it. This

perception was true across income levels: 67

percent of adults with annual incomes under

$50,000 said they would not be able to afford

treatment, as did 30 percent of those with

incomes between $75,000 and $100,000 and 25

percent of those with incomes above $100,000.

In addition to those with the lowest income

level, other groups most concerned about

affording addiction treatment include those with

a high school degree or less (65 percent), those

living outside of metropolitan areas (56 percent)

and adults ages 18-34 (56 percent). The survey

also found that 75 percent believe that people

with addiction may not get treatment because

they lack insurance coverage or cannot afford

it.^134

Cost is a barrier to seeking treatment even for

people with adequate health insurance.^135 Some

addiction treatment programs do not accept any

insurance payments--private or public--for their

services,^136 and insurance coverage for addiction

treatment, when it exists, often has higher co-

pays and limited service coverage.^137

People with private insurance tend to have

greater concerns about cost and are likelier to

cite cost as a barrier to treating addiction than

people with Medicaid or Medicare. Those with

public insurance focus more on accessibility

issues (waiting times, eligibility) as barriers to

treatment.^139 This disparity may be due to the

fact that some private insurance companies do

not cover addiction treatment and some

employers do not extend their benefit plans to

include addiction treatment coverage.^140

Twenty-eight percent of respondents to the

NABAS think that one of the main reasons why

people do not get the help they need for

With the current funding stream, you must be

very rich or very poor to get treatment.^138

--Johnny Allem

Founder and President

Aquila Recovery, Chartered

Former President and CEO

Johnson Institute