Are We Recovery Ready?

There is an urgent need for increased substance use disorder (SUD) treatment. The COVID-19 pandemic exacerbated existing challenges in behavioral health.  Social isolation, economic hardship, and increased stress levels created a fertile ground for increased SUD as many individuals turned to substances as a mechanism to cope with anxiety, depression, and other emotional distress caused by the pandemic’s impact. Additionally, disruptions in health care services, including limited access to treatment facilities and reduced availability of support groups, hindered the recovery process for those struggling with SUD.

According to the 2021 National Survey on Drug Use Health (NSDUH):

• Among people aged 12 or older in 2021, 61.2 million people (or 21.9 percent of the population) used illicit drugs in the past year. One in three young adults 18 to 25 used cannabis in the past year.
• In the past year, 9.2 million people 12 and older misused opioids.
• Over 46 million (46.3 million) people aged 12 or older (or 16.5 percent of the population) met the applicable DSM-5 criteria for having an SUD in the past year, including 29.5 million people who were classified as having an alcohol use disorder and 24 million people who were classified as having a drug use disorder.
  • The percentage of people classified as having an SUD in the past year, including alcohol use and/or drug use disorder, was highest among young adults aged 18 to 25 compared to youth and adults 26 and older.
• Notably, 94 percent of people aged 12 or older with an SUD did not receive any treatment. Nearly all people with a SUD who did not get treatment at a specialty facility did not think they needed treatment.

It is crucial to prioritize and expand SUD treatment resources, including comprehensive rehabilitation programs, counseling services, harm reduction strategies, and access to medication for addiction treatment (MAT). By doing so, the nation can more effectively address the growing SUD crisis and provide much-needed support for individuals seeking recovery in the post-pandemic era.

Improving access to SUD treatment in the United States requires a multifaceted approach involving various strategies. In our experience working with providers and communities across the country, we have found that some of the most effective ways to enhance access to SUD treatment include:

1. Insurance coverage and parity: Ensuring that health insurance plans cover SUD treatment services on par with other medical conditions is crucial. Implementing and enforcing mental health and addiction parity laws, such as the Mental Health Parity and Addiction Equity Act of 2008, can help remove barriers to treatment and increase access for individuals seeking care. In July 2023, the Biden Administration announced new actions intended to improve and strengthen mental health parity requirements and ensure that more than 150 million Americans with private health insurance can better access behavioral health benefits under their insurance plan.
2. Affordable and accessible services: There are several policy levers that can help in reducing financial barriers by making treatment more affordable and accessible. By expanding Medicaid coverage, leveraging opioid abatement dollars and state and federal funding programs, communities can increase funding for SUD treatment programs.
3. Integrated care: Integrating behavioral health treatment services into primary care settings can help normalize the treatment process and reduce stigma. This approach ensures that individuals receive comprehensive care, addressing both their physical and behavioral health needs.
4. Telemedicine and digital solutions: Utilizing telemedicine and digital platforms can increase access to SUD treatment, especially in underserved areas or for individuals with limited mobility. Telehealth services allow remote consultations, therapy sessions, and medication management, providing convenient and timely care. NOTE: In February, the Drug Enforcement Administration (DEA) released proposed rules related to the prescribing of buprenorphine for the treatment of Opioid Use Disorder via telehealth. Stakeholders should closely watch the final rules.
5. Workforce development: Expanding and diversifying the SUD treatment workforce is essential to meet the increasing demand for services. Training and incentivizing health care professionals – including primary care providers, nurses, and social workers – in SUD treatment methodology can help bridge the treatment gap.
6. Community-based initiatives: Supporting and funding community-based organizations that provide SUD treatment and support services can enhance access at the local level. These organizations can offer counseling, peer support, harm reduction strategies, and outreach programs tailored to the community’s specific needs.
7. Public awareness and education: Increasing public awareness about SUD, reducing stigma, and promoting early intervention and prevention efforts can encourage more individuals to seek treatment and support. Education campaigns targeted at communities, schools, and health care providers can help disseminate accurate information and resources.

Third Horizon Strategies (THS) supports system-wide efforts to improve access, quality, cost-efficiency, and patient experience through SUD treatment payment reform. The Alliance for Addiction Payment Reform is a cross-sector learning collaborative that has brought together leading health experts and stakeholders to support the design and implementation of alternative payment models for SUD since 2017. THS also works to improve behavioral health delivery systems by providing strategic consultation to providers, payers, and state and local government agencies. By implementing these strategies and adopting a comprehensive approach, the United States can make significant progress in improving access to SUD treatment, ensuring that individuals receive the care they need to achieve long-term recovery.