Running head: THE ADDICTION TREATMENT GAP

An Analysis of the Addiction Treatment Gap

Farris Jones
The University of South Carolina

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Introduction:
In order to effectively analyze the social problem that is a lack of
necessary treatment for those who suffer from addictions, it is important to
first define what the term addiction is, how it will be referred to in this paper
and the perspectives that will be used to analyze the problem. According to
the American Society of Addiction Medicine (2011) addiction is defined as a
primary, chronic disease of brain reward, motivation, memory and related
circuitry. Dysfunction in these circuits leads to characteristic biological,
psychological, social and spiritual manifestations. This is reflected in an
individual pathologically pursuing reward and/or relief by substance use and
other behaviors (p. 1).
For the purposes of this paper, addiction will primarily focus on the
chronic disease that revolves around the need for substances such as legal
drugs, illegal drugs, and alcohol. In 2007 the Substance Abuse and Mental
Health Administration determined alcohol was the primary substance of
addiction. Alcohol along with opiates (heroin), marijuana, cocaine, and
stimulants (in order of greatest to least prevalence) accounted for 96%
addictions in need of treatment in 2007 (p. 3). This means that there are
numerous substances or things that can cause an addiction, but this analysis
will mainly focus on addictions caused by alcohol and the drugs that were
just described. In short, an addiction is a disease in which an individual is
dependent on some sort of unhealthy substance that provides what the

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individual perceives as relief, but in fact is detrimental mentally and

physically.
There are many factors that contribute to an addiction, the ASAM goes
on to state Genetic factors account for about half of the likelihood that an
individual will develop addiction (p. 3). This same article states that
experiences, culture and the environment are the other primary factors that
contribute to the development of an addiction. What this means is that is
addiction runs in an individuals family, then it is much more likely for them
to develop an addiction. It also means that addiction does not have to run in
ones family to occur, it just raises ones chances peoples personalities and
experiences also shape the likelihood of developing an addiction. For
example, if alcoholism runs in someones family, this individual also had a
very addictive personality, and this individual has been exposed to different
settings where the consumption of alcohol has a strong presence, then this
individual would be highly likely to develop alcoholism. This is not to say that
this person definitely will or will not develop this disease, or that someone
without these circumstances definitely wont develop this disease, it is just an
example of someone who is at a higher risk or alcoholism than the general
public. In reality, everyone has some chance of developing an addiction.
The main perspectives that will be used in this analysis of this social
problem are the functionalist perspective and the conflict perspective.
Kendall (2013), when defining the general view of the functionalist
perspective, states a society is composed of interrelated parts, each of

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which serves a function and (ideally) contributes to the overall stability of the
society (p. 21). The functionalist perspective assumes that society functions
through a balanced state, Johnson and Rhodes (2014) makes the point that a
functionalist generally believes if one part changes, all the other parts are
affected and the system may no longer run smoothly (p. 11). Basically, the
functionalist perspective perceives society as a system that is maintained by
the functions of its different parts (whether good or bad); if one of these
parts does not function as it should, then the balance of the larger society
will be disrupted. The functionalist mainly sees the individual as the cause to
whatever social problem he/she may be experiencing.
The conflict perspective takes an opposite viewpoint from the
functionalist perspective. Johnson and Rhodes (2014) describe the conflict
perspective view by stating unlike the functionalist perspective, conflict
theorists argue that social systems are no united or harmonious but are
divided by class, gender, race, or other characteristics that reflect
differences in social power as much as anything else (p. 12). Conflict
perspective derives from Karl Marxs description of the struggle among the
classes. A conflict theorist would view social problems within society as the
product of some sort of power struggle within society; there is not enough
resources in society to provide for everyones needs, only those with more
power can obtain them and those with less power suffer. A conflict theorist
sees society as the primary cause for whatever social issue an individual
may be experiencing. These two unique perspectives will be applied to the

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problem addressed in this paper in an attempt to view this issue from very
different lenses in order to better understand this issue as a whole.

What the Problem is:

With the definition of addiction and the description of the prevalent
perspectives in mind, the societal problem that is occurring will now be
described. According to a publication by the New York Association of
Alcoholism and Substance Abuse Providers (ASAPNYS)(2014) about 23.5
million Americans suffer from addictions. Only one tenth of those who suffer
actually receive treatment (p. 1). This phenomenon that is occurring in
American society is referred to as the addiction treatment gap. The problem
is this: millions of individuals suffer from some sort of an addiction and only a
very few of those individuals have access to or are receiving treatment. The
figure below illustrates the need for treatment:

There are many different explanations offered as to why this is occurring, but
that will be addressed in the next section. In order to analyze this problem,

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the problem can generally be viewed as a lack of or gap in healthcare that is

available to the population of individuals that suffer from addiction.
A functionalist would perceive the phenomenon of addiction as
primarily the fault of the individual and therefor the lack of health coverage
available is not a problem society needs to address. A common functionalist
argument on the topic of addictions is that an addiction is not a disease, it is
a fault of the individual; if addiction is not perceived as an illness or a disease
then there is no reason that resources and funds of the healthcare system
should encompass addiction for treatment. Even if a functionalist does
perceive addiction as a disease, it is often thought that if the individual never
tried the harmful substance in the first place then they would not have this
addiction. While this is true, the NCADD (2010) states in one of their
publications concerning the treatment gap that though the initial use of
drugs or alcohol is voluntary, continued use alters the brain in fundamental,
long-lasting ways (p. 2). Though the initial use of a harmful substance is the
choice of the individual, the resulting addiction is defined as a chronic illness
that can be effectively treated.
A conflict theorist would take an opposing view on this topic. A conflict
theorist would argue that those who possess more power in society have
greater access to the prevention and treatment of addictions. A conflict
theorist might even go as far as to say that addictions are more common
among those who have less power in society and turn to harmful substances
to cope with their lifestyle which puts them at a greater risk of developing an

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addiction. This means that the power struggle in society directly contributes
to the occurrence of addiction and for that reason society should take the
necessary steps to fix this problem and try to prevent it from happening in
the first place. The ASAPNYS (2014) poses the argument, from a conflict
persepective, that unfortunately, our society and health care system have
been slow to recognize and respond to addiction as a chronic but treatable
condition, leaving millions of Americans without access to the treatment and
supportive services they need to sustain their long- term health (p. 1).
Conflict theorists see addiction as a disease that needs to be addressed by
society, while functionalists see addiction as a problem of the individual.

Why this Problem Occurs:

The fact that millions of Americans suffer from addictions and are not
receiving treatment is caused by a lack of access to health services. This
inability to obtain treatment for addictions can be caused by a number of
different things. ASAPNYS (2014) states lack of insurance, inadequate
insurance coverage and insufficient public funds are the primary reasons for
this treatment gap (p. 1). The lack of treatment available to those who
suffer from addictions is the result of the extent of health care coverage in
general. This treatment gap can also partially be attributed to the fact that
many health institutions and people in society do not perceive addiction as a
disease even though it is formally defined as such. The National Council on
Alcoholism and Drug Dependence (NCADD) (2010) conducted a survey in

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New Jersey among those who suffer from an addiction but are not receiving
treatment. The figure below covers the reasons among those surveyed for
why they were not receiving treatment for their illness:

Although this graph is only representative of those in New Jersey, it offers

insight as to why those who suffer from addictions are not receiving
treatment. It is obvious that the primary cause of this problem is the cost or
a lack of coverage. Johnson and Rhodes (2014), when addressing the topic of
health coverage, state the United States is one of the few industrialized
nations where illness or injury can lead directly to financial catastrophe (p.
149).
As far as who is most affected by this issue goes, Cappocia (2010)
states research shows that the impacts of addiction tend to be more visible
within poorer communities with less access to health care and greater
vulnerability to the consequences of alcohol and drug dependence. This
directly mirrors the idea that a lack of treatment is primarily due to a lack of
money to cover the large cost of addiction treatment. Cappocia (2010) goes
on to say the addiction treatment gap is greater for unemployed adults and
young adults aged 18 to 25 yearswomen and men who have limited access

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to health insurance and publicly funded addiction treatment services. And

the treatment gap is disproportionate for all ethnic minority groups except
Asian-Americans. The root of this problem lies in the high cost of addiction
treatment, lack of funding for addiction treatment and insufficient health
coverage for addiction treatment.
When observing the health care system from a functionalist
perspective, Johnson and Rhodes (2014) state functionalists view illness as
dysfunctional because it prevents individuals form performing their assigned
roles (p. 156). Individuals who suffer from addictions fall into this category
of Americans who have an illness. Although it was previously mentioned that
functionalists dont often view an individual with an addiction as having a
disease, they still perceive the individual with an addiction as not properly
functional. A functionalist would tend to believe that those who suffer from
an addiction are ill and, therefor, dysfunctional in society since they are not
able to perform their role. Functionalists also tend to think that if an
individual is a functional member of the workforce and they become ill, then
the problem will correct itself by the individuals job providing care and
treatment for them and, once again, making them a functional member of
society.
When addressing this societal problem through a conflict perspective,
access to treatment or to the health care system is a privilege that not
everyone who is ill has access to. Conflict theorists perceive the purpose of
the institution of health care as mainly producing wealth for those who are

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already wealthy. Johnson and Rhodes, when discussing the conflict view of
health care, state members of the medical establishment, not health care
consumers, determine the demand by deciding what kinds of medical
services and supplies are needed and then providing them at the prices they
set. Often there are inherent conflicts of interest (p. 157). Conflict theorists
believe that our health care system primarily serves to produce wealth,
giving the best treatments to those who can afford it, while those who do not
have the financial means to receive treatment are left on the back burner.

Social Institutions Involved in this Problem:

There are numerous social institutions involved in this issue, the
primary institutions being the health care system (the involvement of the
health care institution in this issue has already been discussed throughout
this paper) and the political system. Johnson and Rhodes (2014) define the
political system as the social institution that establishes a hierarchy of
power and leadership. It is where decisions are made and carried out, either
directly or indirectly (p.41). A conflict theorist would attribute the health
care needs of individuals not being met to the policies that address health
care coverage. Furthermore, a conflict theorist would argue the most
important political decisions are made not by elected officials but by a power
elite, or ruling class, made up of extremely wealthy individuals who enjoy
easy access to the centers of U.S. politics (Johnson & Rhodes, 2014, p. 57).

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A functionalist views the political system as one of negotiation and

compromise (Johnson & Rhodes, 2014, p. 57). The lack of policy addressing
health care coverage and the treatment needs of those who suffer from an
addiction is not perceived as a problem in the functionalists mind, but rather
as a result of a functioning political process in which power is widely
dispersed and change is slow (Johnson & Rhodes, 2014, p. 57). The
functionalist believes that problems in society will correct themselves over
time through the political system since the functionalist views the political
system as effective and not corrupt.
Other social institutions that could be involved in this phenomenon are
education and the media. Education about drugs and alcohol is emphasized
when discussing the prevention of addiction all together. A conflict theorist
would say that our education system lack appropriate prevention measures,
while a functionalist would tend to think otherwise. The media also plays a
huge part in influencing almost all facets of peoples lives in society. Johnson
and Rhodes (2014) claim that mass media manages the flow of images and
ideas across society; they are a common source of information and a source
of socialization (p. 179). If the media depicts drugs and alcohol as fun and
cool then the chances of addiction will increase, if the media depicts drugs
and alcohol as harmful then the chances of addiction will decrease.

What Can Be Done:

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In order to address this problem, social works must continue to

advocate for those who suffer from addictions. On a micro level, social
workers should work with those who suffer from addictions whether they
have access to treatment or not. On a macro level, social workers should
support and advocate for policies that expand the availability of health
coverage to all individuals and policies that support addiction treatment in
medical coverage. Social workers are called to advocate for all human
beings, especially those who are vulnerable (NASW Code of Ethics, 2008).
Those who suffer from an addiction are certainly vulnerable and in need of
help.
Within a functionalist frame, a social worker could work to help the
individual overcome his or her addiction and the problems in ones life that
result from it. The functionalist social worker helps address addiction as an
individual problem. In order to help the individual that suffers from an
addiction, a functionalist social work approach would be based on
rehabilitating the individual and helping he/she overcome the problem and in
the end making the individual a productive member of society and the
individuals unique systems once again.
A social worker, from a conflict perspective, would likely focus on
correcting the treatment gap, as conflict theory perceives the treatment gap
as a result of discriminations against those who have an addiction. From this
perspective, a social worker would try to correct the political system
addressing health care and try to reduce the stigma that exists against those

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who have an addiction. Through a conflict perspective, a social worker tries

to break down this particular power struggle in order to change the outcome
of the system. In this case, the power struggle would be representative of
those who have an addiction struggling to receive treatment.
As far as organizations go, efforts to include addiction treatment in
healthcare coverage should be taken. It is important to de-stigmatize
addictions on a national level; a changed attitude on the topic would lead to
more help for those who are suffering. Organizations should take on a social
work perspective and help protect individuals with addictions. Capoccia
(2010) states anorganizedvoiceofconsumersandfamiliesadvocatingforfullaccess

toqualityaddictiontreatmentservicescanincreasethepotentialforallcommunitiesto
realizethepromisesofhealthcarereform.Wemustdemandthesamelevelofaccessto
carethatindividualswithotherchronichealthcareconditionshavealreadyobtained.
From a functionalist perspective, organizations function through the
different roles of individuals; in order to continually function smoothly, these
organizations should take care of individuals so that, in return, everything
functions as as it should. This means organizations should contribute to
rehabilitating those with addictions. From a conflict perspective, it is the duty
of organizations that have influence in society to end discrimination on all
different levels. This means that organizations should advocate for broader
health care coverage and funding for addiction treatment.

Conclusion:

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The addiction treatment gap is a prevalent social issue concerning our

nations health care coverage. While certain laws have been implemented in
the last few years addressing this issue, the results have yet to be
experienced. Whether observed from a functionalist or conflict perspective,
the fact of the matter is that there is a large portion of individuals that are
suffering from some sort of addiction and are not receiving treatment. Social
workers should strive to examine and address this issue in order to better the
quality of life for all vulnerable individuals and populations, even those
defined by the suffering of an addiction.

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References
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November 25, 2014, from http://www.asam.org/for-thepublic/definition-of-addiction
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Johnson, M. & Rhodes, R. (2014). Human Behavior and the Larger Social
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Kendall, D. (2013). Sociology in our times (9th ed.) Belmont, CA: Wadsworth.
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