Likelihood of Treatment Access and Barriers to Treatment by Substance Use Recovery Status Among United States Adults.

BACKGROUND: The process by which individuals change their substance use is personal and often non-linear, with periods of recovery, return to use, and treatment re-entry. This study characterizes utilization of substance use services and barriers to treatment access among United States (U.S.) adults with a self-identified lifetime alcohol and/or drug use problem who are versus are not in recovery. METHODS: This study uses a subset of adults from the 2023 National Survey on Drug Use and Health (NSDUH) who self-identified as having had a problem with alcohol and/or drugs at some point in their lifetime (unweighted n=5,260, 38.4% female, 24.5% people of color). RESULTS: Most participants (72.9%) self-identified as being in recovery. Individuals in recovery (relative to those with a lifetime problem but not in recovery) were more likely to report past-year substance use treatment (aOR=1.48); this difference appeared to be driven by the greater likelihood of using support groups (aOR=1.53) and peer support specialists or recovery services (aOR=1.17) among those in recovery. No differences were observed for other treatment types. Among those with past-year perceived unmet need for treatment (8.0% of the overall sample), individuals in recovery were significantly less likely to endorse concerns regarding stigma (aOR=0.25) and readiness to change (aORs=0.17-0.20). Otherwise, no differences were observed for other barriers. CONCLUSIONS: Our findings highlight stigma as a unique distinguishing feature between those who are and are not in recovery from a substance use problem. Stigma-reducing interventions are needed to ensure that a greater proportion of individuals receive effective treatment. CLINICAL IMPACT STATEMENT: Of people with a lifetime self-identified problem with alcohol and/or drug use, most also self-identified as being in recovery. We found that people in recovery were more likely to use support groups and peer-based services, while stigma stood out as a unique barrier to accessing treatment among those not in recovery. Increasing access to recovery-focused services might help to promote a recovery identity, thereby reducing stigma as a barrier to accessing treatment.