Substance use disorder (SUD) continues to be one of the most pressing public health issues in the United States. According to a recent report by the Substance Abuse and Mental Health Services Administration (SAMHSA), 48.5 million Americans aged 12 and older were affected by SUD in 2023. Despite this alarming statistic, only 4.5% of these individuals sought or received treatment for their condition. This huge gap between the number of people struggling with substance use and those receiving the necessary care underscores a systemic issue that needs immediate attention—the SUD treatment gap.
The 2023 SAMHSA National Survey on Drug Use and Health reveals troubling insights into why so many Americans do not seek treatment for substance use disorders. The findings also highlight significant barriers to accessing care, from a lack of awareness to the stigma surrounding addiction, and a growing reliance on certain types of treatment modalities such as outpatient services and telehealth. These findings highlight the pressing issue of the SUD treatment gap, which remains a significant challenge to public health.
The Stark Reality: Millions of Americans With SUD, But Few Seek Help
SAMHSA’s 2023 report paints a striking picture of the substance use crisis. The 48.5 million Americans suffering from SUD is a figure that demands attention, yet it also highlights a worrying trend: only 4.5% of these individuals sought treatment for their disorder. This SUD treatment gap suggests that either there is a lack of resources available to those who need help, or more likely, people are simply not accessing the care that could improve or even save their lives.
One key reason identified by SAMHSA is that many people with substance use disorders do not believe they need treatment. Almost 95% of adults with SUD who did not seek care reported that they did not feel treatment was necessary. This points to a lack of understanding about the nature of SUD and the profound benefits of seeking help. For many, the symptoms of addiction may be normalized or dismissed, preventing individuals from seeing treatment as a viable or necessary option. This is a key aspect of the ongoing SUD treatment gap—people don’t see the need for help until the disorder has escalated to a severe level.
SAMHSA’s report also found that a significant number of individuals who acknowledged needing help did not pursue treatment for a variety of reasons, including feelings of self-reliance, lack of readiness, or resistance to change. These factors compound the SUD treatment gap and create further obstacles in addressing the needs of those suffering from substance use disorders.
Breaking Down the Barriers: Why Aren’t More People Seeking Treatment?
SAMHSA’s survey highlights three main reasons adults with SUD who felt they needed treatment chose not to seek it:
- Self-reliance: Nearly 75% of individuals who did not seek treatment believed they could manage their substance use on their own. This belief in self-control can be a significant barrier to reaching out for help. Many people think they can simply stop using or cut back on their own, even though addiction is a complex disease that often requires professional intervention.
- Readiness to start treatment: 65% of respondents who avoided treatment said they were not yet ready to start. The readiness to enter treatment is often influenced by personal and psychological factors, such as fear of change, perceived stigma, or uncertainty about the treatment process. This reluctance adds to the ongoing SUD treatment gap.
- Resistance to change: 60% of those who chose not to pursue treatment reported they weren’t ready to stop or cut back on their substance use. This reluctance is a powerful reflection of the psychological hold that addiction has over people’s lives, where the immediate comfort or relief that substances provide outweighs the long-term benefits of recovery.
The Stigma of Addiction: A Major Roadblock to Treatment
Stigma continues to be one of the most significant barriers preventing people from seeking treatment for substance use disorders. Addiction has long been viewed through a moral lens, with many perceiving it as a personal failing rather than a complex, chronic health condition. This judgment can lead to feelings of shame and isolation, making it even more difficult for people to ask for help. For many, admitting the need for treatment becomes not only a challenge but a source of fear due to the potential for public judgment and discrimination. The stigma surrounding addiction continues to perpetuate the SUD treatment gap, preventing many from reaching out for the care they need.
This stigma is particularly harmful when it comes to the use of medication-assisted treatment (MAT), which includes life-saving medications like buprenorphine and methadone. These medications are essential tools in managing opioid use disorder, but the stigma surrounding their use can prevent people from starting or maintaining treatment. Misinformation and negative perceptions about MAT often lead individuals to avoid these effective treatment options, prolonging their struggle with addiction. The result is a growing SUD treatment gap that prevents people from accessing potentially life-saving medications.
Shifting Trends: Popularity of Outpatient Services and Telehealth
While the treatment gap remains concerning, there are some encouraging trends emerging in the landscape of substance use disorder care. Outpatient services have become the most widely utilized treatment modality for those with SUD. In 2023, 9.8 million people aged 12 and older received outpatient services for SUD. This is particularly significant because outpatient treatment allows individuals to receive care while still maintaining their daily lives and responsibilities, such as work or family obligations. For many, outpatient treatment is more accessible and less disruptive than inpatient care.
Interestingly, over 80% of individuals receiving outpatient care in 2023 did so in settings other than general medical clinics or doctor’s offices. This indicates a growing trend towards specialized care facilities that are better equipped to address the unique needs of people with substance use disorders. These facilities often offer more intensive, tailored treatment programs that can be critical in helping individuals recover.
The shift toward outpatient care also aligns with broader trends in healthcare, where insurers and investors are increasingly favoring more cost-effective and accessible care models. Inpatient and residential care options, while crucial for more severe cases of addiction, have faced challenges in attracting patients and securing funding. Payers have often pushed back against these higher-cost services, further exacerbating the SUD treatment gap.
Telehealth: A Game-Changer for Accessing Care
Telehealth has emerged as a transformative tool in the fight against substance use disorders. In 2023, 4 million people accessed treatment via telehealth services. The appeal of telehealth lies in its convenience, affordability, and accessibility. For individuals who may have difficulty attending in-person appointments due to geographic barriers, transportation issues, or work schedules, telehealth offers a critical alternative. It allows people to connect with therapists, counselors, and addiction specialists from the comfort of their homes, making treatment more flexible and convenient than ever before.
The rise of telehealth has been especially important during and after the COVID-19 pandemic, which disrupted traditional healthcare delivery systems. As telehealth continues to evolve, it is likely to remain a key component of SUD treatment, offering greater access to care for underserved populations. By making treatment more accessible, telehealth helps to narrow the SUD treatment gap, especially for individuals in rural or underserved areas.
The Rise of Peer Support and Other Complementary Services
In addition to traditional treatment modalities, the survey found that many individuals with SUD are turning to complementary services for support. Nearly 6 million people participated in support groups in 2023, while 2.3 million sought help from peer support specialists or recovery coaches. These services offer an invaluable source of support and guidance for those in recovery, as peer support specialists are often individuals who have lived through addiction and recovery themselves. This shared experience can make the support feel more authentic and relatable.
Peer support services have also proven to be cost-effective. Companies specializing in this area are not only making a significant impact on patient outcomes but also attracting major investment. For example, Marigold Health, a virtual peer support startup, raised $11 million in Series A funding in June 2023. This funding boost demonstrates the growing recognition of peer support as an essential part of the recovery process and its potential for scaling to reach more individuals. As more people turn to peer support, it could play a significant role in addressing the SUD treatment gap.
Other services that have gained popularity in the SUD space include detoxification and withdrawal support, which helped 1.2 million people in 2023. These services are crucial for individuals who need medical supervision and support as they begin their recovery journey, particularly those experiencing physical withdrawal symptoms from substances like alcohol or opioids.
Conclusion: Addressing the Treatment Gap
The findings from SAMHSA’s 2023 report highlight a significant gap in the treatment of substance use disorders in the United States. Despite the millions of people affected by SUD, a staggering number of individuals are not accessing the treatment they need. The reasons behind this gap are multifaceted, ranging from a lack of understanding about the importance of treatment to the pervasive stigma surrounding addiction. This ongoing SUD treatment gap is a public health crisis that requires immediate action.
However, there is hope. Outpatient services, telehealth, and peer support are all playing important roles in expanding access to care and improving treatment outcomes. As these services continue to grow, there is potential for broader, more equitable access to care for individuals with SUD. By addressing the barriers that contribute to the SUD treatment gap, we can make strides toward a more comprehensive and inclusive treatment landscape.
To make real progress in addressing the substance use crisis in America, we must continue to dismantle the stigma surrounding addiction, educate the public about the importance of treatment, and ensure that care is accessible, affordable, and available to all who need it. With a more compassionate and holistic approach to treatment, we can help more people reclaim their lives from substance use disorders and begin to close the SUD treatment gap for good.
