services can be extremely limited.^219 However,
even with greater motivation and better access to
treatment, the environment in which many
homeless people spend their time--with high
rates of ambient substance use, crime and
violence--may present additional barriers to
seeking and receiving treatment.^220
Lack of collaboration between social service
providers, public health systems and addiction
treatment programs is another significant
obstacle to addressing addiction in the homeless
population, resulting in a missed opportunity to
increase access to treatment.^221
Homeless individuals, who frequently have co-
occurring addiction and mental health disorders,
often are rejected by community-based
residential programs since housing programs for
the mentally ill frequently exclude substance
users, and those for substance users often
exclude those with serious mental illnesses.^222
One study found that 60 percent of homeless
people who admitted to having addiction
reported that they were not eligible for addiction
treatment or subsidized housing. Forty-two
percent of those who did receive treatment
reported that their treatment was ineffective
because of a lack of aftercare and housing
services.^223
Another study found that receipt of public
insurance was the strongest predictor of access
to treatment among homeless people relative to
other predictors. Jail stays, emergency
department visits and non-residential medical
care visits were not associated with increased
access to treatment, suggesting that referral links
between these services and addiction treatment
are not adequate.^224
Veterans and Active Duty Military ............................................................................
According to the U.S. Department of Defense’s
Task Force on Mental Health, service members
may be concerned that their substance-related
problems might impede their career
advancement, which can lead them to avoid
seeking timely care.^225 Soldiers may be
reluctant to seek treatment for addiction because
self-referrals can be reported to their superiors;
the military has an established policy of
reporting mental health and substance-related
problems to superiors.^226 The use of illicit drugs
or the misuse of controlled prescription drugs
can be grounds for dishonorable discharge.^227Any referral for additional mental health care in
a military treatment facility must be documented
in an individual’s personal record which can
deter people from seeking such treatment.^228
Data from 2007 show that since military
operations began in Iraq, army commanders
have dismissed more than twice as many
soldiers for drug use* than they did in the same
period before the war.^229 Drug use is
categorized as a form of “misconduct,” which
discontinues some or all military benefits.^230Another barrier to accessing treatment for
veterans is the long wait time for initial
appointments or between appointments.^231
Veterans with co-occurring health problems also
face barriers to treatment, including the practice
of requiring individuals to be substance free
prior to entering treatment for other co-occurring
conditions that are common among military
personnel, such as post-traumatic stress disorder
(PTSD).^232More generally, there is a significant shortage of
medical and mental health professionals to
address the complex medical and psychological
treatment needs of individuals returning from
military combat, as well as those of their family
members.^233Rural Populations .......................................................................................................
Rural populations face a considerable gap in the
receipt of needed addiction treatment.^234
Limited accessibility to treatment services as a
function of geographic location presents a
significant obstacle to treatment access for
people living in rural areas^235 since general
medical and specialty treatment services
typically are located in urban centers.^236 Only
8.9 percent of all addiction treatment facilities
are located in a rural county that is not adjacent* The use of illicit drugs or the misuse of controlled
prescription drugs.