Many Uninsured Workers Who Need Substance Use Treatment Do Not Receive It

A number of uninsured full-time workers with substance abuse problems don't receive the treatment they need, according to a Feb. 4 study conducted by the National Survey on Drug Use and Health.

According to the report Substance Use Treatment Need Among Uninsured Workers, (4-page PDF; About PDFs) an estimated 3 million uninsured full-time workers, out of more than 18.4 million uninsured full-time employees, ages 18-64, believed that they needed substance use treatment during 2007-2008.

Researchers asked respondents a series of questions to determine whether they had health insurance. Those who worked 35 hours or more per week were categorized as full-time employees. Respondents were classified as having substance use problems if they met the criteria for dependence or abuse or if they had received substance use treatment at a specialty facility during the past year. Those who had not received treatment in the past 12 months then were asked if there was any time during this period that they felt they needed substance abuse treatment.

Daniel Vinson, M.D., M.S.P.H., a professor in the family and community medicine department and the Opal Lewis Distinguished Faculty Scholar at the University of Missouri School of Medicine, Columbia, concentrates a majority of his studies on screening and intervening for patients with substance disorders. He told AAFP News Now that he has seen many uninsured patients at the university with drug or alcohol problems.

"The association between substance use problems and lack of insurance is a spiral," Vinson said. "People with drug and alcohol problems have a harder time getting a job, and when they can get one, it may (come) without insurance. Lack of insurance leads to less treatment, which leads to perpetuation of alcohol and drug problems. Each problem makes the other worse."

In fact, the survey indicates that of the uninsured full-time workers who needed substance abuse treatment during the past year, only 12.6 percent received treatment. The remaining 87.4 percent needed treatment but did not receive it. However, of the patients who did not receive treatment, 80.8 percent did not perceive a need for treatment.

Among uninsured workers, the need for substance treatment was higher among males than females, and decreased with age. About 13.3 percent of participants needed alcohol use treatment, and 5.6 percent needed illicit drug use treatment; 2.7 percent needed both.

The study results expose the importance of health insurance in relation to substance abuse problems. "Given the health, economic and social consequences of untreated substance use disorders, uninsured workers need access to effective substance use treatment services and high quality care," says the report.

It adds that "Addressing the substance use treatment needs of uninsured workers with treatment and recovery services that are coordinated and integrated with primary health care may result in improved health outcomes and greater productivity."

Family physician Richard Blondell, M.D., director of the Center for Clinical Addiction Research and Education at the State University of New York at Buffalo and a researcher in the university's department of family medicine, said that at his previous practice, he treated about 100 uninsured patients per year with substance abuse problems.

"There are two main reasons why uninsured patients have substance abuse problems," Blondell said. "One is that, normally, employees have lost their job with insurance because of their substance abuse problems. The second is that these people tend to take jobs compatible with a substance-using lifestyle."

According to the report, the reason for so many uninsured workers is because many low-wage jobs do not have health insurance benefits. As health insurance premiums have increased, many employers have limited the coverage they provide or have passed increased costs along to employees through higher premiums, deductibles or co-payments, leading many low-wage workers to drop coverage, even if it is offered.

Vinson believes that the United States needs to devote more time and attention to preventing drug and alcohol abuse, whether a patient has insurance or not. "There are many options for receiving help, such as state-funded alcohol treatment programs or mutual health groups," he said. "Patients need to seek out a physician who is skilled and compassionate in dealing with these issues."