Associations between past-year receipt of government assistance, Medicaid, and substance use treatment utilization among adults with substance use disorder in the United States.

Aim: Most people who need substance use disorder (SUD) treatment do not receive care, often due to costs and lack of health insurance. We investigated whether receipt of government assistance and Medicaid among people with SUDs was associated with past-year SUD treatment use. Methods: We included working-age adults (ages 18-64) with any SUD from the 2015-2019 National Survey of Drug Use and Health (n = 21,461). Government assistance was categorized as past-year receipt of ≥1 assistance programs (e.g., SSI, SNAP, welfare, cash assistance). We estimated the adjusted odds of past-year SUD treatment in a) any or b) specialty settings by government assistance or Medicaid receipt using separate logistic regressions among people with past-year SUD. We controlled for socio-demographics (sex, age, race/ethnicity, marital status, education, poverty, urbanicity, employment, private insurance) and survey-year. Results: Among people with SUD, approximately 23 % received government assistance and 19.6 % received Medicaid. Receiving both (12 %) was associated with increased adjusted odds of SUD treatment use in any (aOR = 2.30, 95 % CI: 1.78, 2.97) and specialty (aOR = 2.72, 95 % CI: 2.05, 3.62) treatment settings. Receiving assistance from one or more government programs was associated with approximately 50-60 % higher odds of SUD treatment in any setting and 70-90 % higher odds in specialty settings. Conclusion: Medicaid and government assistance receipt were associated with higher SUD treatment use among people SUD, potentially lowering barriers to treatment access. Receiving at least one government assistance program also increased the likelihood of treatment utilization. Future research should examine which specific government assistance programs may drive associations.