Understanding the Problem and Possible Solutions

A Project of State Associations of Addiction Services (SAAS) and Advocates for Human Potential Inc.

"Amazingly, the vast majority of people who need but do not receive treatment for a serious drug or alcohol problem don't even recognize they have a problem. Americans must begin to confront drug use - and drug users - honestly and directly. We must encourage those in need to enter and remain in treatment before it's too late, before they become a mortality statistic."
    -- Former SAMHSA Administrator Charles Curie, press release, June 7, 2005

Untreated people with addictions face death. They suffer complicated health problems and related costs, their productivity at work is compromised, they jeopardize their families, endanger others, and end up in jail. The consequences to society are obvious and enormous.

Finding and treating these individuals, and helping them maintain recovery over time, is a difficult challenge that requires action from many organizations. But the complexity of the task should not be an excuse for inaction. The substance use disorders field needs to take up the challenge, before more individuals become mortality statistics, in former Administrator Curie's words. Organizations and professionals driven by a mission to prevent and treat addiction and help people to long-term recovery are in a position to take leadership and develop solutions to this problem.

Most of the people who have diagnosable substance use disorders do not perceive the need for treatment. Of more than 20 million people who needed but did not receive alcohol or drug treatment in 2003, 95 percent did not recognize their need for treatment. In no other area of public health would society accept the fact that the vast majority of individuals with disease are untreated.

State Associations of Addiction Services (SAAS) and Advocates for Human Potential, Inc. (AHP) are undertaking an initial project, with support from SAMHSA, to establish the research base for what is hoped will be a longer-term initiative that seeks to rectify the public health problem that most people with diagnosable substance use disorders receive no treatment. SAAS and AHP will work with SAMHSA to develop strategies and models for identifying and engaging individuals in treatment and, over time, raise the awareness of the treatment and recovery support services community about this untreated population and promote a new commitment to serving them.

The project will begin by establishing a research base on the target population of potential consumers who have diagnosable illness, barriers to receiving treatment - including those imposed by the payment system - and models of interventions that are effective in other arenas of public health. Conducted with an emphasis on moving from science to practice, our effort to gather information and synthesize the findings will include:

1. Secondary data analysis including a review of those states with the highest successful treatment entry and completion rates (e.g., determining the contributions of other social service systems, public policies, interventions/initiatives, insurance and financing issues, and model drug laws to their successes). The project will analyze payment disincentives, workforce obstacles, and other barriers to identifying, reaching, and treating people who do not receive care for their substance use disorder.

    

2. Review of the literature from public health and other fields on reluctant or hard-to-reach populations and summary and analysis of these findings.

    

3. Identification and recommendation of best practice approaches for identifying, engaging, and treating hard-to-reach populations and supporting their recovery over time. The review of best practices will cover a wide variety of health, public health, and social service environments, including international efforts. The review will include understanding how, why, and for whom the intervention worked, analyzing the potential application to those with substance use disorders, and assessing the barriers and limitations to transferability.

    

4. Development of a summary briefing of findings and meeting by conference call with a Provider Expert Panel to present the findings and solicit their recommendations on the most promising set of actions to reach untreated individuals and bring them into treatment; the summary briefing will be revised after consultation with the Panel and a final briefing held.