Abstract for: Feedback Effects of Acceptability, Affordability, Accessibility, and Quality on Drug Addiction Treatment and Remission

Abstract The American addiction treatment system is a large and complex system encompassing 14,000 facilities serving over 1 million clients annually. This system serves but a fraction of all persons who have an addiction, as most people with a probable substance use disorder (SUD) do not perceive a need for treatment. Among those who do perceive a need, they face many barriers to receiving treatment including finding aspects of treatment unacceptable, unaffordability, and inaccessibility. The prevailing mental model is that increasing access to and affordability of treatment is the preferred way to assist people in their recovery. However, acceptability barriers to treatment must also be considered, as well as the extent to which an already over-burdened system can handle any increased demand without declines in quality. The interacting feedback effects between accessibility, affordability, acceptability, and quality that drive receipt of treatment must be considered holistically. This paper describes an initial attempt at considering this complex system more holistically, with a focus on whether increasing access and affordability alone will improve remission outcomes, or whether unintended consequences and policy resistance are potential outcomes. The focus is specifically on drug use disorders involving illicit drugs other than marijuana.