By Bob CurleyThe latest National Household Survey on Drug Use and Health reported a decline in marijuana use, but also spotlighted a more-disturbing downward trend -- a falloff in the number of Americans receiving specialty treatment for alcohol and other drug addiction.
According to the survey, 22.2 million Americans -- 9.3 percent of the population -- needed addiction treatment in 2003. But just 3.3 million people received any kind of treatment last year, including the estimated 1.9 million individuals who took part in self-help groups like Alcoholics Anonymous.
Citing these numbers, the survey suggests little overall, year-over-year change in the number of people getting "treatment" during the past year. But that's deceptive, says Ron Hunsicker, executive director of the National Association of Addiction Treatment Providers.
"Self-help should not be considered treatment," he said, "but the fact that it is is an indication of how tenuous the notion is that this is a disease."
Specialty treatment programs -- defined as inpatient or outpatient addiction rehabilitation centers, hospital-based inpatient programs, and mental-health centers offering addiction services -- treated a total of about 1.9 million people in 2003, or only 8.5 percent of those who actually needed care. This represented a significant decline from 2002, when an estimated 2.3 million Americans were treated in specialty programs -- down 17.3 percent in a single year.
"This decline was driven by a decrease in treatment among adults ages 26 and older, from 1.7 million in 2002 to 1.2 million in 2003," the report noted.
The definition of specialty treatment excludes treatment at hospital emergency rooms and hospital outpatient programs, private doctors' offices, self-help groups, and prisons or jails. David Gustafson, director of the Network for the Improvement of Addiction Treatment and the Paths to Recovey program at the University of Wisconsin at Madison, said any number of factors could explain the decline in use of specialized addiction programs, from patient dissatisfaction with specialty treatment to lack of insurance coverage.
"I don't think people are consciously making a decision," said Hunsicker. "I think they are being shifted -- they're being blocked from specialty treatment and seeking help elsewhere."
More treatment is being delivered via the criminal-justice system, added Gustafson, and physician prescription of buprenorphine also could be having an impact on utilization of specialty treatment. "I think you could argue for any of these," he said.
The Household Survey noted that at least 273,000 people who felt they needed to get treatment in 2003 were unable to get it. About one-third of those who were ready to get treated said cost or insurance barriers prevented them from getting care; about 20 percent said they were deterred by stigma. "The barriers to treatment continue to mount, despite the spin that the federal government puts out about opening up more treatment slots," said Hunsicker.
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