Unmet Substance Use Service Needs and Barriers Among US Adults In Abstinent and Non-Abstinent Recovery

Background and Purpose: The persistent gap between the need for treatment and recovery services and the accessibility and utilization of those services remains a central concern in addiction care. This gap may be more pronounced among people pursuing non-abstinent treatment and recovery goals, who have been historically underserved within addiction services. Research has shown that most people in recovery continue to use alcohol and other drugs at some level, and that complete abstinence is not necessary for positive health and social outcomes. Yet, addiction care remains dominated by abstinence-only policy and practice, potentially limiting engagement among people with non-abstinent recovery goals. Information on unmet service needs and barriers to service engagement among people in recovery can inform the development of recovery support services that are acceptable and responsive to people traveling diverse recovery pathways. This study estimated the prevalence of unmet service needs and barriers to service engagement among a national sample of US adults in abstinent and non-abstinent recovery.

Methods: Cross-sectional survey data from the 2024 National Survey on Drug Use and Health (NSDUH) were weighted to be representative of the US noninstitutionalized civilian population. The analytic sample included 4052 adults in self-identified recovery, both abstinent (no past-month alcohol or other drug use, n=1346) and non-abstinent (any past-month alcohol or other drug use, n=2706). Logistic regression models were fitted to assess associations between abstinence status and past-year service use and perceived service need, adjusting for age, sex, racial-ethnic identity, urbanicity, employment, insurance status, legal system involvement, household composition, and psychological distress. Among those who perceived an unmet service need (n=112), barriers to care were examined overall and stratified by abstinence status.

Results: Compared to adults in abstinent recovery, those in non-abstinent recovery were less likely to use recovery services (AOR=0.34, 95% CI=0.26-0.44) and more likely to perceive no need for services (AOR=1.95, 95% CI=1.47-2.60). Although only a small proportion of adults in recovery perceived an unmet service need (0.62% and 3.38% among those in abstinent and non-abstinent recovery, respectively), the odds of perceiving an unmet service need were significantly greater among those in non-abstinent recovery (AOR=4.50, 95% CI=1.76-11.52). Outcome expectations (e.g., the belief that services wouldn’t help) were the most prevalent barrier to care, overall and across both abstinent (99.26%) and non-abstinent (76.73%) groups. Logistical (e.g., transportation challenges, 78.66%) and availability (e.g., couldn’t find preferred provider, 70.86%) barriers were frequently reported among those who were abstinent, whereas readiness (e.g., not ready to stop using, 72.31%) and stigma (e.g., anticipated social repercussions, 68.78%) barriers were more prevalent among those who were non-abstinent.

Conclusions and Implications: In 2024, an estimated 529,067 US adults in recovery perceived an unmet service need, the vast majority of whom were non-abstinent. These findings underscore the need to expand recovery services that accommodate non-abstinent goals. Efforts to increase public awareness of the availability and efficacy of services that do not require complete abstinence may address barriers related to outcome expectations, readiness, and stigma, thereby reducing unmet service needs and improving outcomes for people in recovery.