Trends in access to addiction treatment, 1984-2004

Only a fraction of Americans with current substance abuse or dependence – 9 to 15% depending on the survey – have obtained treatment for their problem. The objective of this study is to investigate changes in access to care for substance abuse problems in key subpopulations defined by gender, age, ethnicity, income and insurance coverage. The analysis examines changes on the national level in access to care over the past 20 years. This period has witnessed tumultuous changes in health care financing and delivery, including significant declines in private funding for substance abuse services, the widespread adoption of cost containment through managed care, and in many states, the removal of alcohol and drug rehabilitation as a covered benefit in Medicaid. Drawing on survey data from the 1984, 1990, 1995, 2000 and 2004 waves of the National Alcohol Survey, a wide range of substance abuse services are considered, including specialty care provided in alcohol and drug treatment programs, care through mutual aid groups, such as Alcoholics Anonymous (AA), and through non-specialty medical, psychiatric and social service settings. Findings suggest some promising developments, such as the expansion of access to care among women. However, they also reveal declines in specialty care for some minority groups, as well as a diminished role for private insurance as factor promoting access to care. This work was made possible through a sequence of awards from the National Institute on Alcohol Abuse and Alcoholism Center grant program to the Alcohol Research Group (AA-05595).