Treatment Use Among U.S. Adults with a Substance Use Disorder: Associations with Symptom Severity, Problem Self-Perception, Comorbid Mental Illness, and Mental Health Treatment

Using data from the 2022 and 2023 National Survey on Drug Use and Health, we examined factors associated with treatment use for substance use disorder (SUD), perceived SUD treatment needs, and reasons for treatment non-use. Of U.S. adults, 18.1% had any past-year SUD (alcohol use disorder [AUD] and/or any drug use disorder [DUD]), 14.4% of those with SUD received SUD treatment in the past year, and 5.5% of those who did not receive treatment had a perceived need for treatment. Treatment use was significantly associated with AUD and DUD severities (aOR = 3.85, 95% CI = 2.82–5.26 for severe AUD; aOR = 2.82, 95% CI = 2.27–3.47 for severe DUD), problem self-perception (aOR = 2.12, 95% CI = 1.74–2.58), and mental health treatment use (aOR = 6.07, 95% CI = 4.73–7.78). Perceived treatment needs among those who did not use treatment were also significantly associated with AUD and DUD severities, problem self-perception, and any mental illness. The most frequently reported reasons for treatment non-use among those with perceived need were self-sufficiency beliefs, lack of readiness to stop using or start treatment, stigma-related concerns, and health insurance/cost problems. The findings underscore the importance of screening SUD and educating about the harms of untreated SUD in increasing motivation and readiness for treatment use among people with SUD.