Barriers to Substance Use Treatment | Colorado Health Institute

Colorado has made strides in reducing stigma associated with seeking mental health services. But data from the Colorado Health Access Survey (CHAS) suggest there’s work to do regarding treatment for alcohol and drug use; fear and stigma are keeping many Coloradans from getting needed substance use care.

One in five Colorado adults drinks alcohol excessively (defined as four or more drinks consumed in 2-3 hours for women and five or more drinks consumed in 2-3 hours for men). More than 1,800 Coloradans died from a drug overdose in 2022. Nationwide, 32% of adults report knowing someone who died of a drug overdose.

Evidence-based treatments for drug and alcohol use are available and covered by Colorado Medicaid as well as insurance plans offered on Connect for Health Colorado. Yet data from the 2021-2023 Colorado Health Access Surveys (CHAS) showed that nearly 100,000 Colorado adults (2.2%) did not get needed treatment or counseling for alcohol or drug use.

The CHAS provides insights on who did not get needed substance use treatment and why. Due to small sample sizes, this brief cites combined data from the 2021 and 2023 CHAS surveys. These surveys asked respondents the same questions regarding use of and barriers to needed substance use treatment.

The most frequently cited barriers were discomfort talking with a health professional, cost, and concern that someone would find out. Younger Coloradans ages 18-30 and rural Coloradans were more likely to cite stigma and discomfort talking with health professionals. Additionally, Coloradans with disabilities were more likely to not get needed treatment.

Coloradans didn’t feel comfortable talking with a health professional about their drug and alcohol problems.

When asked why they did not get needed substance use services, Coloradans were most likely to say they did not feel comfortable talking with a health professional about their personal problems (66.5%). Other reasons for not getting needed services were worries about cost (56.8%), concern that someone would find out (51.1%), not thinking their insurance would cover it (43.7%), and having a hard time getting an appointment (32.7%).

Younger Coloradans ages 18-30 were more likely to feel uncomfortable talking with a health professional, with 82.8% citing this barrier compared with 59.4% of Coloradans ages 31-49 and 68.2% of those ages 50-64.

Stigma kept rural Coloradans from seeking needed substance use treatment.

Just over half (51.1%) of all Coloradans who did not get needed treatment cited concern about what would happen if someone found out.

This was a greater concern for rural Coloradans, with 69.5% reporting this barrier compared with 48.5% of Coloradans living in urban areas. Rural Coloradans were also slightly more likely to cite discomfort with talking to a health professional, with nearly seven in 10 (72.3%) reporting this barrier compared with 65.8% of urban Coloradans.

Coloradans with disabilities were more likely to not get needed substance use treatment.

Coloradans who reported difficulty performing daily activities because of any physical, mental, or emotional condition were more likely to report forgoing needed drug and alcohol treatment than those without these conditions (4.3% vs 1.7%).

Overall, males were more likely to not get needed substance use treatment than females. In addition, Coloradans ages 31-49, as well as those who identified as Hispanic/Latino or Non-Hispanic Other Race also were more likely to report forgoing needed drug and alcohol treatment. Lastly, Coloradans who identified as LGBTQ+ were more likely to report forgoing needed treatment.

Middle-income Coloradans were more likely to cite insurance barriers.

Coloradans with household incomes between 139-400% of the Federal Poverty Level (this group includes families of four with incomes between $41,700 and $120,000) were more likely to not think their insurance would cover needed treatment than those with lower or higher incomes. While not all people with incomes below 138% FPL are covered by Colorado Medicaid, CHAS data suggest greater awareness of benefits among those with lower incomes.

Find Help

Colorado Crisis Services provides confidential and immediate support, information, and counseling referrals for substance abuse. Call 844.493.TALK (8255), text TALK to 38255, or visit 4353 East Colfax Ave., Denver, Colo. 80220. Se habla español, and interpreter services are available.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides 24-hour free and confidential treatment referral and information about substance use disorders, prevention, and recovery. Se habla español. Call 800.662.4357 (HELP), TTY: 800.487.4889.