The role of perceived need and health insurance in substance use treatment: implications for the Affordable Care Act.

The expansions in insurance coverage under the Patient Protection & Affordable Care Act (ACA) that took full effect in 2014 have been projected to increase the number of users of behavioral health services. By analyzing data from the 2008-2012 National Survey on Drug Use and Health, this paper examines whether health insurance expansion may result in an increase in substance use disorder (SUD) treatment utilization. The study sample includes 18,600 adults with SUD but no diagnosable mental health condition. The analysis finds that over 80% of that population receives no treatment and 97% do not perceive a need for treatment. When they do receive treatment, they are more likely to receive mental health treatment. Using multinomial logistic regression, the study finds that having Medicaid or private insurance is associated with higher likelihood of receiving SUD treatment, but only when individuals perceive a need for it, compared to being uninsured and not perceiving a need for treatment (the reference category). These results indicate that increased service utilization is associated with perceiving a need for substance abuse treatment, implying that outreach initiatives to raise awareness about SUD and the effective role of substance use treatment are needed to enhance the impact of the structural changes to the substance abuse treatment system resulting from the ACA.