Background: In addition to marijuana, methamphetamine, and cocaine, which have been cited as drugs of abuse in rural areas for several years, the misuse of prescription pain relievers has increased alarmingly in rural and urban areas over the past decade. Despite these increases in drug use, access to substance abuse treatment remains insufficient in many rural communities.
Objectives: To investigate how insurance expansions under the ACA are associated with substance use treatment amongst metropolitan, micropolitan, and other non-metropolitan residents satisfying criteria for a substance use disorder (SUD).
Methods: We analyzed nationally representative data from the National Survey on Drug Use and Health (NSDUH) for the years 2008-2015. NSDUH is a series of nationally and state-representative surveys administered in-person and the primary source of information on substance use behaviors by the U.S. household population. We first conducted descriptive analyses to compare and contrast across metropolitan, micropolitan, and other non-metropolian areas the prevalence of 2 key access indicators (perceived unmet need for substance use treatment and the receipt of any substance use treatment) among adults ages 18-64 who satisfied criteria for a past year SUD. We next conducted regression analyses to estimate the effects of insurance expansion on these access indicators, adjusting for individual-level demographic, self-rated health, and economic characteristics.
Results: Analyses revealed increasing rates of perceived unmet need (89%, 91%, and 94%) and lowering rates of the receipt of any substance use treatment (11%, 9%, and 6%) amongst other non-metropolitan, micropolitan, and metropolitan residents with a SUD. The expansion of insurance via the ACA was not significantly associated with unmet need or the receipt of substance use treatment amongst metropolitan, micropolitan, or other non-metropolitan residents with a SUD.
Discussion and Conclusions: Our findings indicate that substantial unmet needs for substance use treatment remain among residents of non-metropolitan and metropolitan areas alike. We suspect that the capacity of the substance use treatment system may not have sufficiently expanded to keep up with any increased treatment demand taking place after insurance expansion. Because insurance expansion as part of the ACA appears to have had no significant effect on treatment, additional policies and organizational interventions are arguably warranted to improve access to substance use treatment.