Substance Use Treatment Need among Uninsured Workers
In Brief
More than 18.4 million full-time employees aged 18 to 64 (15.5 percent of the full-time adult workers in that age range) had no health insurance coverage
Full-time workers represented the majority (54.5 percent) of adults under age 65 without health insurance coverage
An estimated 3.0 million uninsured full-time workers (16.3 percent) needed substance use treatment in the past year; specifically, 13.3 percent needed alcohol use treatment, 5.6 percent needed illicit drug use treatment, and 2.7 percent needed both alcohol and illicit drug use treatment
Of the uninsured workers who needed substance use treatment in the past year, 12.6 percent (378,000 persons) received treatment at a specialty facility
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.
Employment and Health Insurance
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.
Table 1. No Health Insurance Coverage among Full-Time Employees Aged 18 to 64, by Sociodemographic Characteristics: 2007 and 2008
Sociodemographic Characteristic
No Health Insurance Coverage, Number (in Thousands)
* Data were suppressed because of low precision.
Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
Treatment Need
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
Figure 1 Table. 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
Demographic Characteristics
Percent Needing Treatment
Aged 18 to 25
24.4%
Aged 26 to 49
15.5%
Aged 50 to 64
6.9%
Male
19.2%
Female
11.2%
Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs)
Receipt of Treatment
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
Figure 2 Table. 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
Receipt of and Perceived Need for Treatment
Percent
Did Not Receive Substance Use Treatment and Did Not Perceive a Need for Treatment
80.8%
Received Substance Use Treatment
12.6%
Did Not Receive Substance Use Treatment but Perceived a Need for Treatment
6.6%
Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
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
Figure 3 Table. 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
Demographic Characteristic
Percent Receiving Treatment
Aged 18 to 25
10.5%
Aged 26 to 49
12.1%
Male
14.4%
Female
6.9%
* Data for the 50 to 64 age group were suppressed because of low precision.
Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
Discussion
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.
End Notes1 Claxton, G., DiJulio, B., Whitmore, H., Pickreign, J., McHugh, M., Finder, B., & Osei-Anto, A. (2009, September 15). Job-based health insurance: Costs climb at a moderate pace. Health Affairs, 28(6), w1002-w1012. 2 Bureau of Labor Statistics. (2009, July 28). Table 2. Medical care benefits: Access, participation, and take-up rates (Economic News Release). Retrieved on January 20, 2010, from http://www.bls.gov/news.release/ebs2.t02.htm 3 Employee Benefit Research Institute (EBRI). (2009, July). Chapter 4: Participation in employee benefit programs. In EBRI databook on employee benefits. Retrieved on January 20, 2010, from http://www.ebri.org/publications/books/index.cfm?fa=databook 4 NSDUH defines dependence on or abuse of alcohol using criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which includes such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year. For details, see the following resource: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. 5 Substance use treatment at a specialty facility is defined as treatment received at drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient services only), and mental health centers. Specialty substance use treatment excludes treatment in an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. 6 Use of illicit drugs includes use of marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically. Nonmedical use is defined as use not prescribed for the respondent by a physician or used only for the experience or feeling the drug(s) caused. Nonmedical use of any prescription-type pain reliever, sedative, stimulant, or tranquilizer does not include over-the-counter drugs; nonmedical use of stimulants includes methamphetamines.
Suggested CitationSubstance Abuse and Mental Health Services Administration, Office of Applied Studies. (February 4, 2010). The NSDUH Report: Substance Use Treatment Need among Uninsured Workers. Rockville, MD.
The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2007 and 2008 data used in this report are based on information obtained from 10,210 persons aged 18 to 64 who were employed full time and were without health care insurance. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.
The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)
Information on the most recent NSDUH is available in the following publication:
Office of Applied Studies. (2009). Results from the 2008 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 09-4434, NSDUH Series H-36). Rockville, MD: Substance Abuse and Mental Health Services Administration. Also available online: http://oas.samhsa.gov.
The NSDUH Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.