People with disabilities (PWD) are at higher risk of experiencing substance use disorders (SUD) than those without a disability.1, 2, 3 In the US alone, more than 40 million adults live with a disability; this population has elevated prevalence of any drug use, as well as prescription drug misuse, daily nicotine use, and other drug use.4 In addition, PWD are at elevated risk for alcohol “abuse”5 and binge drinking.6 Furthermore, intravenous drug use among PWD is much higher when compared with adults without disabilities.7

While pharmacological and behavioral treatment exists for SUD,8 which can significantly reduce mortality, morbidity, and substance use-related harms,9 numerous barriers to entering and remaining in treatment have been documented. In the general population, common barriers include individual factors, such as lack of information about how to access treatment or the belief that treatment for SUD is not effective, but also structural factors, such as cost, inadequate reimbursement rates, lack of treatment facilities or transportation, racism, stigma, and other forms of discrimination.10,11

Treatment access, perceived need for treatment, and barriers to receiving SUD treatment among PWD have only recently begun to be explored. The available literature suggests that PWD, despite high SUD risk, experience lower access to SUD treatment than people without disabilities. For example, a case-control study using Medicaid data from Washington State12 shows important health disparities, with PWD 40 % less likely to receive any medication for opioid use disorder (MOUD) and, if enrolled in treatment, 13 % less likely to continue treatment (after six months) than people without a disability. Although there is limited research on factors underlying such disparities in SUD treatment access, research conducted among PWD who misuse opioids or with an opioid use disorder in Massachusetts suggests that barriers such as stigma and lack of accommodations, coupled with the effects of gender, race, and homelessness, combine to negatively affect PWD's ability to access MOUD.13

Relative to the overall population of PWD, individuals experiencing certain specific types of disabilities may also face compounded barriers to SUD treatment. Relying on data from the National Health and Nutrition Examination Survey (2013–2018), Hinson-Enslin et al. suggest that despite increased odds of lifetime drug use, those experiencing vision loss alone, hearing loss alone, or both vision and hearing loss were no more likely to receive treatment than those without disabilities.14 Regardless of disability type, lack of support from the social environment, such as caregivers, family members, or other sources, has been found to be a barrier to SUD treatment.15

Existing and perceived barriers may result in an unmet need for substance use treatment in PWD who sought treatment or thought they should receive treatment but did not receive it. Even though empirical studies on this topic are scarce, for US adults with co-occurring mental health and substance use disorders, low perceived need and barriers to care are associated with low treatment coverage.16 Qualitative research adds that disability status intersects with racial identity to shape experiences of stigmatization in SUD treatment.13

Currently, there are no national-level studies examining the differences between US adults with and without disabilities in terms of substance use disorder treatment receipt, perceived need for treatment, and barriers to receiving treatment. We therefore employed the most-recent data from the National Survey on Drug Use and Health (NSDUH)17 to fill this gap in the literature. Identifying patterns of SUD treatment access, perceived unmet need, and barriers within a population of PWD and those without any disability can contribute to the design of a more effective and inclusive treatment policy. Such policies should address the entire cascade of care18 -from screening to diagnosis and treatment-for this marginalized, at risk population.