It’s a common belief that the majority of people struggling with addiction take drugs like heroin and cocaine and that addiction treatment centers are primarily filled with these addicts, with the main issue being getting more illicit drug users into treatment. In reality, the picture is much more complicated, and looking at treatment utilization in terms of the drugs people abuse is surprisingly illuminating. Additionally, the evidence on the proportion of who needs addiction treatment versus those who receive it may help us answer difficult questions about how to improve access to treatment and even discover whether access to treatment is the core issue.
Different Drugs and Rates of Addiction
Data from the 2012 National Survey on Drug Use and Health (NSDUH) provide insight into the most important drugs in terms of the rates of substance use disorder (addiction) in America, as well as the proportion of users of each drug who receive treatment. It may not come as a surprise that 64.5 percent of people struggling with addiction in America primarily abuse alcohol. Marijuana is the second most common drug of choice at 15.7 percent, while prescription opioids account for 7.5 percent of all addictions. In comparison, heroin is the primary substance in only 1.7 percent of addictions and cocaine in 4.1 percent.
However, the rates of people who use a specific substance and who become addicted basically turn this on its head. For marijuana, 9 percent of those who use it are addicted and another 5 percent are abusers, and for alcohol, 6 percent of users are addicted and another 7 percent are abusers. For heroin, a massive 65 percent of those who use it are addicted. For cocaine, the figure is 17 percent.
How Many Abusers and Addicts Get Treatment?
Despite the fact that most addicts choose alcohol as their primary drug, only 6 percent of all alcohol addicts receive specialty treatment (“specialty” treatment as defined by the survey doesn’t include AA, however), and, similarly, only 12 percent of marijuana addicts receive treatment. For cocaine, 33 percent of all people with substance abuse disorder get treatment, and for heroin it’s 63 percent. In other words, people with heroin use disorder were about 10 times more likely to receive treatment than people abusing alcohol or marijuana, despite accounting for only one in 50 addicts in America. The figures become even more shocking when all non-medical users are considered: just 0.83 percent of alcohol users and 1.62 percent of marijuana users get treatment. For heroin, 43.8 percent of users get treatment.
Data from the National Epidemiological Survey on Alcohol and Related Conditions (conducted between 2001 and 2005) show that (including AA) only 8.1 percent of drug abusers and 37.9 percent of drug-dependent individuals attend treatment in their lifetimes. Despite these low numbers, lifetime recovery rates are fairly high, suggesting that while it likely takes a lot longer, most people will eventually overcome their addictions.
Gulf Between Needing Treatment and Thinking You Need It
NSDUH data show that the vast majority of those meeting the Diagnostic and Statistical Manual for Mental Disorders criteria for substance abuse or dependence don’t think they need treatment; 84 percent of drug abusers or dependent individuals said this in 2012. Eleven percent received specialty treatment, another 3 percent thought they needed help but didn’t pursue it, and the remaining 2 percent tried to find help but couldn’t.
There are many potential reasons for this, but denial of the issue is obviously a factor, especially with “socially acceptable” drugs like alcohol or pot. Most addicts or people who know addicts will recognize the denial of needing help even in spite of clear signs to the contrary. However, there is an unavoidable issue from this data when it comes to calling for better access to treatment—people are more likely to not try to find treatment (even when they think they need it) than to try to find it but be unable to get it. The Affordable Care Act increases access to mental health treatment, but will people make use of it?
Getting More People Into Addiction Treatment
These figures hint at an uncomfortable reality. While we may think of heroin abusers as being the people most in need of treatment, the evidence shows that they are much more likely to get help but simultaneously make up a much smaller proportion of people struggling with addiction. Almost two-thirds of addicts are drinkers, but only around one in 20 will get help. It seems like this is the biggest oversight in how we look at addiction and treatment: we need to realize (and to help others realize) that alcohol addiction is a serious issue that does need to be addressed with structured treatment.
Raising awareness is one approach, but it would also be prudent to look for ways of making treatment a more appealing option for drinkers and pot-smokers — they need help the most, but rarely look for it. Funding for addiction treatment should continue to increase, but we also need new ideas as to how to best use that funding and to get people who don’t feel like they need help to realize that they do. Improving availability is one part of the battle; the other is encouraging people to take advantage of the help on offer.