Treatment Access and Retention

Issues of Access

Access to treatment can be understood at the socio-cultural, systemic, organizational, and individual levels. First, sociocultural factors may contribute to treatment [Page 933]access. The current social and political climate regarding substance use treatment can influence community perceptions and decision making about funding and supporting treatment. Social stigma and decreased public funding for treatment can dissuade individuals from seeking treatment. Treatment access can also be conceptualized at the system level, where various community health care agencies interact to provide treatment. These agencies may include methadone maintenance clinics and recovery homes but also health clinics, prisons, workplaces, and welfare programs, which serve as entry points for treatment. Individuals may have greater access to treatment if these systems collaborate effectively. For example, in some states, individuals arrested for drug-related offenses may be diverted to substance use treatment instead of incarceration. Through this approach, treatment access is provided to clients who might not otherwise seek treatment due to lack of finances or low treatment motivation.

A recent view of treatment access that focuses on the organizational level of analysis suggests that issues of treatment access can be attributed to the health care system. These issues include policies on the amount of funding that goes toward substance use treatment services. Lack of public funding for treatment can alter the services available, result in less space for additional clients and staff, and inflate treatment costs for clients. There have also been cutbacks to treatment availability in the private sector. The rise in managed care has also led to reductions in access to inpatient care with an increasing reliance on outpatient treatment. Characteristics of treatment programs that may affect treatment entry include long waiting lists for appointments, complex eligibility and admission requirements, lack of cooperation between service organizations, residential treatment facility rule compliance (e.g., restrictions on what residents can bring with them to treatment, lack of contact with family), and absence of appropriate treatment for certain groups (e.g., lack of cultural appropriateness to diverse groups, treatment in other languages, or child-care services for parents with children). System redesign may help to remove barriers for individuals who want to access the care they need.

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