February 4, 2010

Substance Use Treatment Need among Uninsured Workers

In the United States, employer-sponsored insurance is the primary source of health care coverage for persons under the age of 65.¹ However, many low-wage jobs do not include health insurance benefits.² Additionally, as health insurance premiums have increased, many employers have limited the coverage they provide or have passed the increased costs along to the employees through higher premiums, deductibles, or co-payments.¹ This may have resulted in fewer employees choosing to enroll in coverage,³ and it may leave many individuals with untreated medical problems. Although there has been quite a lot of research on the physical health and health care needs of uninsured workers, less is known about their substance use treatment needs. Gaining a better understanding of the substance use treatment needs of uninsured workers may help prevention and treatment providers address the gap between service needs and service receipt.

The National Survey on Drug Use and Health (NSDUH) asks a series of questions to determine whether respondents were covered at the time of the survey by Medicare, Medicaid, the State Children's Health Insurance Program (SCHIP), military health care (such as TRICARE, formerly called the Civilian Health and Medical Program of the Uniformed Services [CHAMPUS]), private health insurance, or any other kind of insurance. Persons who were not covered by any of these types of insurance are classified as uninsured. NSDUH also asks respondents to report whether they worked in the week prior to the interview, and if not, whether they had a job despite not working in the past week. Persons who indicated that they usually worked 35 hours or more per week are categorized as full-time employees.

NSDUH classifies persons as needing substance use treatment if they met the criteria for dependence or abuse or if they received substance use treatment at a specialty facility in the past year.^4,5,6 Respondents who had not received treatment in the past 12 months are asked if there was any time during this period when they felt they needed substance use treatment.

This issue of The NSDUH Report focuses on substance use treatment need and receipt among persons aged 18 to 64 who were employed full time but who did not have health insurance (hereafter referred to as "uninsured workers"). All findings in the report are annual averages based on combined 2007 and 2008 data.

More than 18.4 million full-time employees aged 18 to 64 (15.5 percent of the estimated 118.4 million full-time workers in that age range) had no health insurance coverage, according to NSDUH data averaged for 2007 and 2008. These uninsured full-time workers represented over half (54.5 percent) of the Nation's estimated 33.8 million uninsured adults under age 65.

Full-time workers in some sociodemographic groups were more likely than those in other groups to be without health insurance. Among full-time workers, lack of health insurance was more common among males than females, among younger adults (i.e., aged 18 to 25) than those aged 26 to 49 or 50 to 64, and among Hispanics than individuals in other racial/ethnic categories (Table 1). Education and income also were related to health insurance coverage: Full-time workers with the least education and lowest incomes were the most likely to be without health insurance.

An estimated 3.0 million uninsured full-time workers (16.3 percent) needed treatment for alcohol or illicit drug use in the past year. About 13.3 percent needed alcohol use treatment, and 5.6 percent needed illicit drug use treatment; 2.7 percent were in need of both alcohol and illicit drug use treatment.

Among uninsured workers, the need for substance use treatment was higher among males than females (19.2 vs. 11.2 percent) (Figure 1). The need decreased with age: 24.4 percent among those aged 18 to 25, 15.5 percent among those aged 26 to 49, and 6.9 percent among those aged 50 to 64.

Figure 1. Past Year Need for Substance Use Treatment among Full-Time Employees Aged 18 to 64 Who Were without Health Insurance, by Demographic Characteristics: 2007 and 2008

Of the uninsured full-time workers who needed substance use treatment in the past year, 12.6 percent (378,000 persons) received treatment at a specialty facility (Figure 2). The remaining 87.4 percent needed but did not receive such treatment, including 6.6 percent who recognized that they needed treatment and 80.8 percent who did not perceive a need for it.

Figure 2. Past Year Receipt of and Perceived Need for Substance Use Treatment among Full-Time Employees Aged 18 to 64 Who Were without Health Insurance and in Need of Substance Use Treatment: 2007 and 2008

Among uninsured full-time workers in need of treatment, males were more likely than females to have received treatment at a specialty facility (14.4 vs. 6.9 percent) (Figure 3). There was no statistically significant difference in receipt of treatment between uninsured workers aged 18 to 25 and those aged 26 to 49; estimates for uninsured workers aged 50 to 64 were suppressed because of low precision.

Figure 3. Past Year Receipt of Substance Use Treatment at a Specialty Facility among Full-Time Employees Aged 18 to 64 Who Were without Health Insurance and in Need of Substance Use Treatment, by Demographic Characteristics: 2007 and 2008

Although the public might assume that most adults without health insurance are unemployed or part-time workers, the reality is just the opposite. Over 18 million adults aged 18 to 64 were working full time and had no health insurance coverage; this represents more than half of uninsured nonelderly adults. NSDUH data indicate that there is a substantial need for substance use treatment among uninsured workers—particularly among males and workers aged 18 to 25. Few of those who needed treatment received it. Given the health, economic, and social consequences of untreated substance use disorders, uninsured workers need access to effective substance use treatment services and high-quality care. Addressing the substance use treatment needs of uninsured workers with treatment and recovery services that are coordinated and integrated with primary health care may result in improved health outcomes and greater productivity.

This page was last updated on September 29, 2009.

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.    Site Map | Contact Us | Accessibility | Privacy Policy | Freedom of Information Act  Disclaimer | Department of Health and Human Services | SAMHSA | White House | USA.gov * PDF formatted files require that Adobe Acrobat Reader® program is installed on your computer. Click here to download this FREE software now from Adobe. What's New Highlights Topics Data Drugs Pubs Short Reports Treatment Help Mail OAS