addiction is because of insufficient available and
affordable treatment services.^141 Treatment
providers see this as a barrier to treatment access
as well: CASA Columbia’s survey of treatment
providers in New York State found that
approximately 90 percent of the respondents
said that inability to pay “somewhat” (44.6
percent of program directors and 42.8 percent of
staff providers) or “very much” (45.8 percent of
program directors and 50.7 percent of staff
providers) stands in the way of people receiving
needed addiction treatment.^142
Cost not only is a barrier to entering treatment,
but to staying in treatment as well. One study
found that people randomly assigned to receive
free methadone maintenance therapy stayed in
their treatment programs longer than those
randomly assigned to fee-for-service treatment,
even though the fee was only $2.50 per day.^143
Lack of Information about How To Get Help ...........................................................
A significant barrier to obtaining addiction
treatment is the lack of knowledge about where
to go for help and the limited ability of
physicians, parents and other family members,
teachers, coaches, employers, clergy and law
enforcement to identify the signs of addiction in
others and know how to help patients access
effective treatment.^144 The NABAS found that 16
percent of respondents believe that a main
reason why people with addiction do not get the
help they need is because of insufficient
information about how and where to get help.^145
Limited Availability of Services ................................................................................
A significant barrier to treatment is the lack of
appropriate and accessible treatment services.^146
This barrier is due to insufficient training of
medical professionals and treatment options and
the lack of treatment options tailored to
individual needs; excessively restrictive
eligibility criteria in some treatment facilities;
long waiting times for treatment entry and a lack
of trained addiction physician specialists and a
lack of inclusion of addiction medicine as a
recognized field of practice by the American
Board of Medical Specialties, as discussed in
Chapters IX and X.^Approximately half of respondents to CASA
Columbia’s NABAS reported that insufficient
treatment programs and services for people with
addiction is a somewhat or very serious problem
in their communities.^147 Another national poll
found that nearly half (47 percent) of the
respondents said that treatment services are
lacking in their community; only one quarter
indicated that there are enough affordable,
accessible quality treatment centers and
services.* 148 CASA Columbia’s survey of
treatment providers in New York State found
that a significant proportion of the respondents
said that a lack of conveniently located treatment
programs “somewhat” (62.2 percent of program
directors and 56.8 percent of staff providers) or
“very much” (17.1 percent of program directors
and 21.6 percent of staff providers) stands in the
way of people seeking needed addiction
treatment.^149Some individuals who need addiction treatment
face eligibility criteria for program entry that are
too stringent--including a patient’s ability to pay
and a required agreement to comply with all
rules and treatment protocols regardless of
individual goals.^150 In contrast, the main
criterion for treatment access in mainstream
medicine is the principle of medical necessity,
determined by a physician;^151 patients seeking
medical treatment rarely have to meet a
threshold level of problem severity or agree to
comply in advance with particular rules, unless
those rules are designed to protect the patient’s
health and safety (e.g., refusing to give a patient
a certain medication that is contraindicated for
medical reasons, requiring cessation of certain
medications or behaviors prior to a surgical
procedure).* Those reporting the greatest concern about the
limited treatment options in their communities
included respondents with incomes below $50,000
(52 percent), blacks (67 percent), those who knew
someone with addiction (58 percent) and those who
did not have health insurance (56 percent).