Association for Public Policy Analysis & Management

Research Objective: The role of insurance on substance use disorders (SUD) treatment utilization generally is poorly understood and still less is known on how insurance status relates to the use of evidence-based medication assisted treatment (MAT) compared to other treatments, like self-help groups, where the research on effectiveness is less supportive. This study examines associations between health insurance and any SUD treatment utilization as well as use of self- help versus MAT.

Study Design: A cross-sectional study design was used. Data were from the 2015-2017, public use National Surveys on Drug Use and Health (NSDUH). Any SUD treatment utilization was defined as receiving any drug/alcohol treatment in the past year. Self-help treatment was defined as only the use of self-help groups (eg. Narcotics Anonymous) to treat SUD. MAT treatment was defined as the past year use of outpatient mental health services combined with pharmacotherapy (e.g., methadone, buprenorphine). Insurance status was categorized into no insurance, public (Medicare and Medicaid), and private insurance. Unadjusted associations between SUD treatment use and insurance status were examined using Z tests. Adjusted logistic regressions were used to examine the associations controlling for socio-demographics, recent major depressive episode, and survey year. All analyses used survey weights to be representative of the US population and account for the NSDUH’s complex survey design.

Population Studied: Respondents who self-reported use of alcohol or any licit or illicit drug in the past year were assessed for SUD using assessment of abuse and dependence symptoms based on DSM-IV criteria. 15,393 persons aged ≥ 12 were defined as having SUD.

Principal Findings: Before adjustment, compared to the uninsured with SUD, those with public insurance were more likely to access any SUD treatment (33.9% vs.19.9%, p<0.001). Regarding type of SUD treatment, the publicly insured were less likely than those without insurance to use self-help treatment (39.8% vs. 56.8%) and more likely to use MAT (60.2% vs. 43.2%, p<0.05). After adjustment for covariates, those with publicly insured remained more likely to use any SUD treatment in the past year (odd ratio [OR] 1.82; 95% CI: 1.36-2.43), compared to those without insurance. Further, compared with uninsured, those with public insurance reported lower odds of using only self-help treatment (OR 0.42; 95% CI: 0.23-0.74) versus MAT utilization.

Conclusions: Publicly insured persons with SUD are more likely to use SUD treatment in the past year than the uninsured. Uninsured people with SUD are more likely to use self-help as a substitute for MAT.

Implications for Policy or Practice: Public insurance, especially Medicaid, has taken a central role in treating SUD, while private insurance has lagged behind. These findings demonstrate that members of these public programs are more likely to receive evidence-based treatment, while privately insured and uninsured people continue to use self-help groups as a substitute for MAT. As states continue to develop their SUD treatment infrastructure, understanding current utilization patterns for privately insured and uninsured people is important for targeting this population for referral services (to MAT) in the context of integrated SUD service.