If you have trouble controlling your use of alcohol, opioids, cocaine, or any other addictive substance, you’re not alone. Substance use disorder (SUD), or addiction, is a long-term mental health condition that affects your brain chemistry and behavior. More than 21 million Americans have at least one addiction.
While there’s no cure, you can treat and manage addiction. But not everyone who needs help can easily get it. Only about 10% of those with an addiction of some sort get treatment. Part of the reason for that is the many barriers to accessing substance use treatment in the United States.
What Are Common Barriers to Treatment?
The barriers to finding and getting proper substance use treatment vary from person to person. But structural issues such as cost, transport, access to quality care, as well as systemic issues such as racial and ethnic discrimination, might pose challenges for you.
Common barriers to treatment include:
Cost of rehabilitation and treatment. Treatment for substance use disorder can be expensive. That’s one of the major reasons why many people don’t get the proper care. Depending on the type of treatment you need, it could cost anywhere from $15,000-$27,000. If you have health insurance with good coverage, it may help cover some or most of the costs. If you don’t, the expense can be overwhelming.
Your actual treatment costs depend on many factors, such as:
- Type of insurance coverage
- Length of stay
- Type of treatment program, such as whether it includes visits to a clinic or hospital stay
- Treatment for related physical and mental health issues
- Program location
- Amenities at the rehab facility you choose
- Medication costs
People who are homeless, have substandard housing, or lack employment are likely to find it very difficult to seek help or complete treatment, especially when they can’t meet basic needs.
Geographical limitations. Most substance use treatment and rehab facilities are located in urban areas and in heavily populated states. For example, California has over 2,300 facilities, while Vermont has 62. In fact, you’ll find 92% of addiction centers in big cities.
Large, rural states like Montana, may have treatment facilities in only a handful of locations. This makes it harder to go back and forth for regular care, especially if you live far away.
Not only are there few treatment centers in rural areas, these communities lack licensed substance use specialists who are able to prescribe life-saving drugs. Around 90% of the doctors who can prescribe buprenorphine – a drug commonly used to treat opioid addiction – practice in urban areas. About 53% of rural counties have no doctor who can prescribe this medication, even though there’s a high demand for it.
Some rural areas also lack trained mental health professionals, who can treat substance use disorders. Some 65% of the rural counties in America have no practicing psychiatrist, and 13% lack any behavioral health provider.
Because rural hospitals and addiction care centers tend to have fewer beds, you may have to travel a long way to get care. But rural communities also lack public transport, making treatment more difficult to access.
Stigma. Negative views and judgment around substance use may cause feelings of guilt and shame and affect your decision to get help. One study that looked at reasons why people with SUD didn’t seek help found that some:
- Worried what friends and family would think if they sought treatment
- Don’t like to talk in groups or discuss their problems with other
- Didn’t believe they had a substance use problem
- Didn’t think treatment would help them
Gender discrimination. There are also gender-based barriers to treatment, especially around the issues of pregnancy and child care. Most substance use treatment facilities don’t offer child care. Further, one study found that some doctors may be less likely to prescribe opioid agonist therapies (OATs) to treat opioid addiction when you’re pregnant. That’s despite the fact that OATs like buprenorphine and methadone are known to be safe and work well during pregnancy.
Another study found that emergency medical service personnel were three times less likely to give naloxone – an emergency drug that reverses the effects of opioid overdose – to women than to men.
Women may also be less likely to get help with addiction due to:
- Family responsibilities
- Lower income and lower rates of employment
- Lack of support from family or partners
Racial and ethnic discrimination. Research has shown that black, indigenous, and people of color (BIPOC) are less likely to get and complete treatment for substance use disorder. Because these differences persist after adjusting for socioeconomic factors, some researchers say this indicates that they’re treated differently.
Among the health care and legal disparities surrounding substance use disorder are these:
- While SUD rates are similar among BIPOC and white Americans, BIPOC are more likely to face criminal charges because of it.
- People of color tend to face far worse consequences when they test positive for illegal drug use.
- People of color are not equally represented in clinical studies for addiction treatment. This can result in culturally inappropriate medical treatment.
- Black Americans are less likely to be prescribed buprenorphine for opioid use, though they’re more likely to die from overdoses.
- BIPOC communities are less likely to get preventive medicines and overdose education.
- Because of cultural norms, Hispanics and Asian Americans may choose informal support from family or community members over medical treatment.
Other mental health issues. Some 3.4% of those with SUD also have another mental health condition. This group is less likely to seek help for their SUD, and just 7.4% of them get treatment for both conditions. One problem is that only 18% of substance use programs are equipped to help you manage other health issues. Many people in the prison population have SUD along with another mental health disorder, and have little access to treatment.
What’s Being Done to Remove the Barriers?
Some government agencies and medical groups are taking steps to deal with barriers to treatment for substance use disorder:
- The federal Health Resources and Services Administration is working to expand access to telemedicine for addiction treatment in rural or underserved areas. This form of care allows you to virtually connect with a mental health specialist no matter where you live.
- The Patient Protection and Affordable Care Act (ACA) allows states to expand Medicaid coverage for most low-income adults. This includes everyone under 65 who makes less than $16,643 annually. A total of 38 states and the District of Columbia have opted to expand.
- The American Society of Addiction Medicine has issued a policy statement asking medical professionals to examine their own motivations and practices during their care for BIPOC. It also calls on these doctors to advocate for policies that ensure equal access to SUD prevention and treatment. And it calls for greater equity in research.
Ikiwa una tatizo la kudhibiti utumiaji wako wa kileo, dawa za kulevya, kokeini, au dawa nyingine yoyote inayosababisha uraibu, si wewe pekee. Matatizo ya matumizi ya dawa za kulevya (SUD) ni hali ya afya ya akili ya muda mrefu ambayo huathiri kemikali ya ubongo na tabia. Zaidi ya Wamarekani milioni 21 wana angalau moja ya viungo. Ingawa hakuna tiba, unaweza kutibu na kusimamia uraibu. Lakini si kila mtu anayehitaji msaada anayeweza kupata msaada kwa urahisi. Ni asilimia 10 tu ya watu wenye tabia ya kulevya wanaopokea matibabu. Sehemu ya sababu ya hilo ni vizuizi vingi vya kupata matibabu ya matumizi ya dawa za kulevya nchini Marekani. Ni Vizuizi Vipi vya Kawaida vya Matibabu? Vizuizi vya kupata na kupata matibabu sahihi ya matumizi ya dawa za kulevya hutofautiana kutoka mtu hadi mtu. Lakini masuala ya muundo kama vile gharama, usafiri, upatikanaji wa huduma ya ubora, pamoja na masuala ya mfumo kama vile ubaguzi wa rangi na kikabila, inaweza kuwa changamoto kwa ajili yenu. Vizuizi vya kawaida vya matibabu ni pamoja na: Gharama ya ukarabati na matibabu. Matibabu ya ugonjwa wa kutumia dawa za kulevya yanaweza kuwa ghali. Hiyo ni moja ya sababu kuu kwa nini watu wengi hawapati huduma sahihi. Kulingana na aina ya matibabu unayohitaji, gharama inaweza kuwa kati ya $ 15,000. Ikiwa una bima ya afya na chanjo nzuri, inaweza kusaidia kufunika baadhi au zaidi ya gharama. Ikiwa hufanyi hivyo, gharama zaweza kuwa kubwa sana. Gharama za matibabu ya kweli hutegemea mambo mengi, kama vile: Aina ya bima, urefu wa kukaa, aina ya mpango wa matibabu, kama vile ikiwa inajumuisha ziara za kliniki au kukaa hospitalini, matibabu ya masuala yanayohusiana na afya ya mwili na akili, eneo la programu, vifaa katika kituo cha ukarabati unachochagua, gharama za dawa, watu wasio na makazi, wana nyumba duni au hawana kazi ya kuajiriwa wanaweza kupata shida sana kutafuta msaada au kumaliza matibabu. Vizuizi vya kijiografia. Vituo vingi vya matibabu na ukarabati wa matumizi ya dawa za kulevya viko katika maeneo ya mijini na katika majimbo yenye watu wengi. Kwa mfano, California ina zaidi ya vituo 2,300, wakati Vermont ina 62. Kwa kweli, asilimia 92 ya vituo vya kulevya viko katika miji mikubwa. Majimbo makubwa ya mashambani kama vile Montana, huenda yakawa na vituo vya kutibu magonjwa katika maeneo machache tu. Hii hufanya iwe vigumu kwenda na kurudi kwa ajili ya utunzaji wa kawaida, hasa ikiwa unaishi mbali. "Hakuna vituo vya matibabu katika maeneo ya vijijini, lakini pia kuna ""mafundi wa dawa za kulevya"" ambao wanaweza kuagiza dawa za kuokoa maisha." Karibu 90% ya madaktari ambao wanaweza kuagiza buprenorphine - dawa inayotumiwa kwa kawaida kutibu ulevi wa opioid - hufanya kazi katika maeneo ya mijini. Karibu asilimia 53 ya wilaya za vijijini hazina daktari anayeweza kuagiza dawa hii, ingawa kuna mahitaji makubwa ya dawa hiyo. Baadhi ya maeneo ya vijijini pia hayana wataalamu wa afya ya akili waliozoezwa, ambao wanaweza kutibu matatizo ya matumizi ya dawa za kulevya. Katika baadhi ya wilaya za mashambani, asilimia 65 hazina daktari wa magonjwa ya akili, na asilimia 13 hazina mtoa huduma wa afya ya tabia. Kwa sababu hospitali za vijijini na vituo vya utunzaji wa uraibu huwa na vitanda vichache, huenda ukalazimika kusafiri umbali mrefu ili kupata utunzaji. Lakini jamii za vijijini pia hazina usafiri wa umma, na hivyo kufanya iwe vigumu kupata matibabu. Uchafu wa kibinadamu. Maoni mabaya na hukumu kuhusu matumizi ya dawa za kulevya inaweza kusababisha hisia za hatia na aibu na kuathiri uamuzi wako wa kupata msaada. Utafiti mmoja ambao ulichunguza sababu kwa nini watu wenye SUD hawakuomba msaada uligundua kwamba baadhi yao: - Walihangaikia nini marafiki na familia wangefikiri ikiwa wangetafuta matibabu - Hawakupenda kuzungumza katika vikundi au kujadili matatizo yao na wengine - Hawakuhisi walikuwa na tatizo la matumizi ya dawa - Hawakuhisi matibabu yangewasaidia ubaguzi wa kijinsia. Pia kuna vizuizi vya kijinsia kwa matibabu, haswa karibu na masuala ya ujauzito na utunzaji wa mtoto. Vituo vingi vya matibabu ya matumizi ya dawa za kulevya havitoi utunzaji wa watoto. Zaidi ya hayo, utafiti mmoja uligundua kwamba baadhi ya madaktari wanaweza kuwa na uwezekano mdogo wa kuagiza matibabu ya opioid agonist (OATs) kutibu ulevi wa opioid wakati wewe ni mjamzito. Hiyo ni licha ya ukweli kwamba OATs kama buprenorphine na methadone ni inayojulikana kuwa salama na kazi vizuri wakati wa ujauzito. Utafiti mwingine uligundua kwamba wafanyakazi wa huduma za dharura za kitiba walikuwa na uwezekano mdogo mara tatu wa kutoa naloxone - dawa ya dharura ambayo inageuza athari za kupita kiasi kwa opioid - kwa wanawake kuliko kwa wanaume. Wanawake pia wanaweza kuwa na uwezekano mdogo wa kupata msaada na ulevi kwa sababu ya: - Majukumu ya familia - Mapato ya chini na viwango vya chini vya ajira - Ukosefu wa msaada kutoka kwa familia au washirika Ubaguzi wa rangi na kikabila. Utafiti umeonyesha kuwa watu weusi, wenyeji, na watu wa rangi (BIPOC) wana uwezekano mdogo wa kupata na kumaliza matibabu ya ugonjwa wa matumizi ya dawa za kulevya. Kwa sababu tofauti hizi kudumu baada ya kurekebisha kwa sababu za kijamii na kiuchumi, baadhi ya watafiti wanasema hii inaonyesha kwamba wao ni kutibiwa tofauti. "Kati ya tofauti za afya na kisheria zinazozunguka ugonjwa wa matumizi ya dawa za kulevya ni hizi: ""Wakati viwango vya SUD ni sawa kati ya BIPOC na Wamarekani weupe, BIPOC wana uwezekano mkubwa wa kukabiliwa na mashtaka ya jinai kwa sababu yake." - Watu wa rangi huwa na kukabiliwa na matokeo mabaya zaidi wakati wao kupima chanya kwa matumizi ya dawa za kulevya haramu. - Watu wa rangi hawawakilishwa kwa usawa katika masomo ya kliniki ya matibabu ya uraibu. Hilo laweza kusababisha matibabu yasiyofaa kiutamaduni. - Wamarekani weusi ni chini ya uwezekano wa kuwa prescribed buprenorphine kwa ajili ya matumizi ya opioid, ingawa wao ni zaidi ya uwezekano wa kufa kutokana na overdoses. - Jamii za BIPOC zina uwezekano mdogo wa kupata dawa za kuzuia na elimu ya overdose. - Kwa sababu ya kanuni za kitamaduni, Wahispania na Wamarekani wa Asia wanaweza kuchagua msaada wa kawaida kutoka kwa familia au wanachama wa jamii juu ya matibabu. Matatizo mengine ya afya ya akili. Asilimia 3.4 ya watu walio na ugonjwa wa akili wana matatizo mengine ya akili. Watu wa aina hii hawawezi kupata msaada wa matibabu kwa sababu ya ugonjwa wao wa haraka, na ni asilimia 7.4 tu ya watu wanaopata matibabu kwa sababu zote mbili. Hata hivyo, ni asilimia 18 tu ya programu za matumizi ya dawa za kulevya zinazokusaidia kusimamia matatizo mengine ya afya. Watu wengi katika idadi ya wafungwa wana SUD pamoja na ugonjwa mwingine wa afya ya akili, na wana upatikanaji mdogo wa matibabu. Ni Nini Kinachofanywa Ili Kuondoa Vizuizi? Mashirika ya serikali na makundi ya matibabu yanachukua hatua za kukabiliana na vizuizi vya matibabu ya ugonjwa wa matumizi ya dawa: Utawala wa Rasilimali na Huduma za Afya wa Shirikisho unafanya kazi kupanua upatikanaji wa telemedicine kwa matibabu ya ulevi katika maeneo ya vijijini au chini ya huduma. Njia hii ya matibabu inakuwezesha kuwasiliana na mtaalamu wa afya ya akili bila kujali unakoishi. Sheria ya Ulinzi wa Mgonjwa na Huduma ya Affordable (ACA) inaruhusu majimbo kupanua chanjo ya Medicaid kwa watu wazima wengi wenye mapato ya chini. Hii inahusisha watu wote chini ya umri wa miaka 65 ambao wanafanya chini ya $ 16,643 kwa mwaka. Kwa jumla, majimbo 38 na Wilaya ya Columbia yameamua kupanua. Shirika la American Society of Addiction Medicine limetoa taarifa ya sera ya kuomba wataalamu wa matibabu kuchunguza motisha zao na mazoea wakati wa huduma yao kwa BIPOC. Pia inawaomba madaktari hawa kutetea sera ambazo zinahakikisha upatikanaji sawa wa kuzuia na matibabu ya SUD. Na inahitaji usawa mkubwa katika utafiti.