Dilemmas of a Broken Substance Abuse System

Woman struggling with Alcohol Abuse and Depression

As a society we know what leads to addiction and how it manifests, but treatment options in America are still largely inadequate. To start, there’s no national standard of care for addiction. Secondly, despite addiction being a chronic illness, treatment programs tend to offer acute interventions, and not long-term treatment programs. [1]

Many treatment programs offer unproven therapies and have little medical supervision. Fourteen states within the United States only require a high school diploma or GED to become an addiction counseling and 10 states only require an associate’s degree [2]. A further 20 states do not require any degree or do not require addiction counselors to be certified or licensed.

The American Society of Addiction Medicine (ASAM) defines recovery as a “process of sustained action that addresses the biological, psychological, social, and spiritual disturbances inherent in addiction…recovery actions lead to reversal of negative, self-defeating internal processes and behaviors, allowing healing of relationships with self and others” [9].

The Reality of Addiction Recovery

A report from Columbia University found that some treatment programs promise ‘one time fixes’ and others offer upscale residential treatment and expensive prices with little evidence based practices for treatment [2].

This report also stated that there are little outcome data that reflects the quality of treatment for patients to make informed choices. This report also published a statement that said, “most people recover completely on their own and by attending self help groups, and/or seeing a counselor or therapist individually [2, 3].

Over 43% of addiction treatment is spent at residential facilities where discharge is typically at the 30 day mark. For addictions, this is not enough time to recovery fully from drugs or substances, and relapse is evident.

Overcoming Financial Challenges

Man with blue eyesPart of the Dilemmas of a Broken Substance Abuse System is financial support. In 2010, the US spent $107 billion to treat heart disease, $86.6 billion on cancer treatment, and $43.8 billion for diabetes, but only $28 billion to treat addiction [4].

Many addiction facilities are not adequately regulated or held accountable for providing treatment that is not consistent with medical standards or proven treatment practices. There are no national standards for who and how addiction treatment is provided. It varies widely state by state.

In a 2005 survey of 1,000 adults, 63% stated they see addiction as personal or moral weakness, and 34% see it primarily as a disease or health issue [4]. Substance abuse which alters both mind and behavior, can have negative outcomes.

Social attitudes, political and legal responses to the use of alcohol and drugs make substance abuse one of the most complex public health issues. More recent research in brain imaging has brought forth the development of medications that can assist in detoxing and withdrawal effects [5].

More research is also occurring within the last decade that looks at the community, environmental and social factors that contribute to addiction, that can lead to more evidence based strategies and treatment.

Addictions make up approximately 9% of the US population, and about 90% of those do not receive treatment. Those 10% that do receive treatment, do not maintain sobriety, meaning that addiction services are not only costly but often ineffective [6].

Addiction benefits as part of the Essential Health Benefits (EHB) benchmark found that many insurance plans provide adequate addiction benefits and 2/3rd violate the ACA [7]. None of the plans reviewed provided comprehensive coverage for addiction. Many plans excluded residential treatment and methadone maintenance therapy.

Working Through Gaps in Addiction Treatment

Dilemmas involved with the broken system leave room for various components to treatment programs. There are many components to substance abuse treatment, which are focusing on the patient’s drug use, employment training, restoring the individual to being a productive member in their family and society, and obtaining abstinence.

Man with dread locks

In the United States over 14.500 facilities provide substance abuse counseling, behavioral therapy, medication, case management, and more [8]. Many local addiction treatments are funded by local, State and Federal governments. Managed care options typically have short stay treatment with lack and insufficient coverage for substance abuse.

Research shows that for every dollar used on substance treatment, there is a return of $4-7 in reduced theft, drug-related crime, and criminal justice costs. With opioid abuse increasing, and ongoing efforts to reform health care, and changing prevention and treatment efforts, laws are providing opportunities to address these concerns [10].

Even though there are increasing prevention programs, many are underutilized. About 11% of youth aged 12-17 report participating in a substance abuse prevention program outside of school [10]. Only 10.4% of people with an addiction actually receive treatment and about 1/3rd of those receive minimal standards of care.

In conclusion, the substance abuse treatment system has a variety of issues in the areas of treatment, insurance coverage, and stigmas around substance abuse. With further funding, standardization of care, and training the substance abuse system can provide further evidence based practices and longer-term continuum of care.


Image of Libby Lyons and familyAbout the Author: Libby Lyons, MSW, LCSW, CEDS, is a Certified Eating Disorder Specialist (CEDS) who works with individuals and families in the area of eating disorders. Mrs. Lyons works in the metropolitan St. Louis area and has been practicing in the field for 11 years. Libby is also trained in Family Based Therapy (FBT) to work with children-young adults to treat eating disorders. Mrs. Lyons has prior experience working with the United States Air Force, Saint Louis University, Operating Officer of a Private Practice, and currently works with both Saint Louis Behavioral Medicine Institute within their Eating Disorders Program and Fontbonne University


[1] https://psychcentral.com/lib/why-americas-addiction-treatment-system-is-broken-what-you-can-do/
[2] https://www.ncbi.nlm.nih.gov/books/NBK64124/
[3] https://psychcentral.com/blog/archives/2013/02/11/the-problems-with-the-u-s-addiction-treatment-system/
[4] http://www.livescience.com/41557-why-america-fails-at-addiction-treatment.html
[5] https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse
[6] https://blog.oup.com/2016/12/dilemmas-broken-substance-abuse-system/?utm_source=feedblitz&utm_medium=FeedBlitzRss&utm_campaign=oupblog
[7] http://www.centeronaddiction.org/addiction-research/reports/uncovering-coverage-gaps-review-of-addiction-benefits-in-aca-plans
[8] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states
[9] http://www.williamwhitepapers.com/pr/IBH%20Creating%20a%20New%20Standard%20for%20Addiction%20Treatment%20Outcomes%202014.pdf
[10] https://addiction.surgeongeneral.gov/vision-future/time-for-a-change

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Reviewed By: Jacquelyn Ekern, MS, LPC on March 18, 2017.
Published on AddictionHope.com

About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.