Let's face it, we've all read and seen things on social media that would make etiquette expert Emily Post's head spin -- perhaps we've even been guilty of posting some egregious things ourselves, maybe when we've had a little too much caffeine or on a spontaneous whim that we realize was a mistake in hindsight.
In today's world, it seems cool to overshare and bare it all. Sex, politics, religion -- everything that was once too taboo for public conversation is now open ground for all the world to see. Yet there remains a topic rarely shared without judgment, one that continues to face tremendous stigma: addiction. Admit it, when was the last time you had a favorable response to a post in which someone openly shared their turmoil with drug or alcohol addiction (not just the occasional late-night partying), or the plight of a loved one? Perhaps you have a connection who posts about it -- and receives their fair share of scoffing and criticism. Truth is, it's one subject that is still considered too embarrassing an admission to discuss openly, yet data indicates we all know someone who struggles with drinking or drugs.
We're not talking (posting, sharing) about it and we're not getting the help we need. That leads me to wonder -- why not?
In 2013, nearly 23 million Americans met diagnostic criteria for substance (drug or alcohol) abuse or dependence. And in that year, 2.5 million of them received treatment. That means that over 20 million Americans experienced enough symptoms to be diagnosed with substance abuse or dependence but did not get treatment. Eighty-nine percent of those who needed care got none. If those were the statistics for heart disease or diabetes, the public would be outraged. Families would be fighting with insurers to get more coverage, employees would demand better coverage in their health plans, and coalitions would be storming our nation's capital.
To be clear, not all of these individuals are presenting for care. Ninety-five percent of them do not perceive a need for treatment. But that still leaves about 1 million -- yes, 1 MILLION -- Americans who perceived a need for treatment but did not get it.
A few reasons stand out as to why.
Resources
Until now, many individuals struggling with addiction have had inadequate health insurance (or none at all) and/or a lack of finances to afford the out-of-pocket cost of treatment. Under the Affordable Care Act (aka "Obamacare"), millions of people now have health insurance, and mental health and substance abuse services are one of the 10 essential benefits that all health plans must cover. Additionally, recent legislation such as the Parity Act require insurance carriers to offer the same level of mental and behavioral health benefits as traditional medical benefits.
These changes could dramatically affect the addiction treatment landscape, bringing affordable care to most every American.
Options
A fair percentage of individuals struggling with addiction did not know where to go for treatment or didn't feel that any treatment programs had what they needed. Many times, it's unrealistic to force someone to travel across the country or even state to get reputable care. Fortunately, in anticipation of the above cited changes in health care, treatment centers are experiencing tremendous growth opportunities, expanding services and locations. Care that is evidence-based, patient-centered, and individualized is becoming more accessible, while more professional and specialty services are being incorporated like yoga, nutrition, art and music therapy, increased availability of psychiatric services and more, all to attract additional patients. Few programs are able to provide clients with a full continuum of care, from intervention through detox, into residential, and on to outpatient and recovery support, although studies have shown that when a patient can get all their services in one location, we reduce the breakpoints that can lead to discontinuation of care and increase the likelihood of recovery success.
Just how does someone find one of these reputable programs with specific services, in a location most convenient to them? One helpful and impartial resource is SAMHSA.gov.
Discretion
Surely, if more people have access to treatment, can afford the cost, and have increased location and service options, we'll see droves coming into treatment any day, right? Not exactly.
Back to my original point, until we as a society take the stigma out of the disease of addiction, until we stop worrying about losing our jobs, our spouse, our kids if we admit we have a problem, and until we accept that addiction is not some moral failing, we may not see much of a dent in the greater than 20 million Americans who do not seek help. We may not even get to the 1 million who do agree they have a problem.
The treatment industry continues to pursue ways to change perception, to educate policymakers and the public about addiction as a chronic disease, but everyone can play a part in reducing stigma.
With over 20 million lives on the line, it certainly deserves our best effort.
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Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.