Nearly 50 million Americans suffer from substance use disorders, and yet less than five percent receive treatment. Why is treatment so poor in America? Why are so few Americans aware of the options for receiving treatments that are proven to be effective in reducing the difficulties arising from substance use disorders?

These are the questions pondered in a far-reaching expose into the poor quality of addiction treatment in the U.S. published in The New York Times on December 13, 2023. The article focuses on addiction recovery coach, Raina Mcmahan, but the authors, Jeneen Interlandi and Damon Winter, dig deep into the statistics on addiction in America. What they find is really a disgrace:

• Nearly 50 million Americans have substance use disorders
• Less than 3 million Americans receiving treatment for substance use disorders
• More Americans died from drug overdose in the past 24 years than in all U.S. wars combined.

There are treatments for addiction available that “have proved just as effective at managing addiction as statins are at managing cholesterol or aspirin is at preventing heart attacks,” say the authors, continuing:

Experience suggests that many more people would make use of these treatments if only they were easier to access: In other countries and in many U.S. states, when the barriers to addiction treatment have been lowered, treatment uptake has increased, and overdose rates have fallen.

Inexpensive addiction treatment can be found, if at all, at the far end of a very expensive system of law enforcement, courts, hospitals, and drug deaths, before, finally, treatment options are discussed, implemented, adjusted, and progress measured. There are fear, stigma and legal liability that come with seeking treatment, the authors note.

Addiction should result in recognition, not stigma. The majority of Americans grow up with substance abuse in the extended family. The fact that people can learn repetitive ways of relieving stress that become unhealthy over time should not be surprising. Treatment is a lifelong process of learning how to right the ship when natural tendencies threaten to careen out of control.

While the track record on addiction treatment in America is abysmal, The New York Times offers suggestions for improving outcomes and saving money by treating substance use upfront, rather than at the far end of the criminal justice system:

• Instead of making good treatment difficult to obtain […] make it as easy and straightforward as possible.
• Clinics should welcome walk-ins.
• Medication should be cheap or free.
• Patients should be met with acceptance instead of judgment.
• Relapse should be treated as part of the recovery process, not cause for punishment.
• Treatment should be voluntary, not coercive.
• Providers shouldn’t wait for patients to come knocking on the clinic door.
• Stop dehumanizing people who use drugs.
• Make use of evidence about which treatments and approaches work and which do not. 
• Address the dire workforce shortages plaguing behavioral health.
• Change the way addiction treatment is funded. 
• Lower the barriers to long-proven therapies like methadone. 
• Ensure that those therapies are accessible to the most vulnerable populations, including the incarcerated (roughly half of whom struggle with addiction) and those newly released from jail or prison.

Here is the harsh takeaway the authors have after looking very closely at the personal lives of people who have been through the system, and broadly at the stats on evidence-based medicine: “The nation’s addiction treatment apparatus is not designed or equipped to deliver evidence-based medicine in the first place.” Ouch!

When it comes to substance use disorders, we do not implement or improve the science. The field is treated and usually housed away from standard medical care, the staff is not paid as well, and the therapies are inspired more often from religious tracts than evidence or measurement.

The New York Times authors take their time trying to find out why, if there are relatively inexpensive methods to treat substance use disorders, they are not implemented. The answer appears to be that people who need help feel victimized — first by the substance, then by the system — where there’s a financial incentive to distance the patient from evidence-based treatment.

We have to leave it there today, but this won’t be the last AddictionNews has to say about this piece in The New York Times and what it says about addiction treatment in America.

Written by Steve O’Keefe. First published December 18, 2023.

Sources:

“48 Million Americans Live With Addiction. Here’s How to Get Them Help That Works,” The New York Times, December 13, 2023.

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