Abstract
Despite the utility of substance abuse treatment, large numbers of people with serious substance use problems do not get the treatment that is needed. Communities that participated in the Robert Wood Johnson Foundation's “Fighting Back” program (see Saxe et al., this issue) developed a range of strategies to facilitate the provision of treatment to community members. As part of the national evaluation of Fighting Back, a general population survey conducted in 1995, 1997, and 1999 in 12 of the Fighting Back communities and 29 comparison communities assessed problem substance use, dependence, and treatment. These data were used to examine whether the gap between treatment need and treatment utilization was reduced in the Fighting Back communities. Results indicated that the discrepancy between treatment need and utilization of specialized treatment was unchanged, with as few as 6% to 7% identified as needing treatment actually receiving treatment. There were, however, a number of characteristics that distinguished those who received treatment from those who did not: (1) females were more than seven times less likely to receive treatment when needed than were males; (2) African Americans were four times less likely and Hispanics three times less likely than White respondents; (3) those 25 years and younger were four times less likely than those over 25; (4) unemployed and those living in poverty were three times more likely to receive treatment. The implications of these findings are that even within comprehensive approaches to substance abuse, more must be done to identify those in need of treatment, to understand the factors that explain the discrepancies between those in need of treatment who do and do not receive treatment, and to develop methods for getting those in need into treatment.