Running head: THE ADDICTION TREATMENT GAP Jones 1

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THE ADDICITON TREATMENT GAPJones 2

An Analysis of the Addiction Treatment Gap

Farris Jones

The University of South Carolina

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 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 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 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, 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 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 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 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 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). 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: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 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 an organized voice of consumers and families advocating for full access to quality addiction treatment services can increase the potential for all communities to realize the promises of health care reform. We must demand the same level of access to care that individuals with other chronic health care conditions have already obtained. 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: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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