The cost of substance use treatment can depend on where you live. These states offer the most financial help.

Health Centers Near Me examined SAMHSA’s substance use and mental health survey  to identify states with free or affordable treatment facilities.
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Beth Mowbray, Data Work By Elena Cox

With drug overdose rates skyrocketing—deaths jumped from 8.2 per 100,000 people in 2002 to 32.6 in 2022, according to the Centers for Disease Control and Prevention—more attention than ever is focused on how to treat the public health crisis of addiction.

Roughly 17% of the U.S. population (48.5 million people aged 12 and up) had a substance use disorder in 2023, according to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health—but most did not receive treatment. In fact, just 0.5% of adolescents and 0.5% of adults with substance use disorders sought out any treatment.

Despite being a life-or-death matter, why are so many people struggling to access the treatment they so desperately need? Roughly 2 in 5 people cited concern that treatment was too expensive, and about a third said they didn’t seek treatment due to the potential fallout, such as losing their job, home, or children, according to the SAMHSA survey.

The combination of social, financial, and logistical barriers can make accessing and receiving treatment exceedingly complex for people struggling with substance use disorder. Compounding issues can feel particularly overwhelming for those in the throes of addiction.

The age-old barrier of stigma continues to rear its ugly head, as many still feel scared or shameful admitting they need treatment for misusing alcohol or drugs. Co-occurring mental health issues can make reaching out for this help even more difficult. Research has shown that individuals struggling with issues like anxiety, depression, and trauma may drink alcohol or use drugs to self-medicate. Although substance use may seem beneficial at first, it tends to worsen mental health symptoms over time.

Lack of access to appropriate services can also be a significant barrier to treatment. The structure of substance use treatment services can vary from state to state, as can the availability and personalization of care. Matters can be further complicated by logistical issues: For example, if programs lack the capacity to meet local demand, such as no available bed in a detox facility, or if a patient doesn’t have reliable transportation to attend the program daily.

The cost of care: financial challenges in treatment

Treatment costs also deter individuals from reaching out for help. Some facilities are private pay only, meaning clients must pay out of pocket and in full for all services, which can be financially devastating. Historically, health insurance has not covered substance use treatment in the same way physical health services are covered.

The Mental Health Parity and Addiction Equity Act, a federal law established in 2008, has made great strides in holding insurance companies accountable for covering such treatment equally, but not everyone has health insurance. Alcohol and drug costs exacerbate financial difficulties for high-risk populations, making it even more difficult to access appropriate—and oftentimes life-saving—care. Research shows people who are unemployed, unhoused, or who live in lower-income communities have higher rates of overdoses.

Finding adequate treatment isn’t impossible, though. Health Centers Near Me examined SAMHSA’s National Substance Use and Mental Health Services Survey to identify states where the highest proportions of substance use treatment facilities offer free or low-cost/sliding-scale treatment for clients who can’t pay. The data represents pay information for the more than 14,000 facilities—both public and private, ranging from outpatient to residential treatment centers and inpatient hospitals—that responded to the survey in 2023, the latest data available.

Read on to learn more about how financial access to care varies across the U.S., as well as steps to take if you or someone you know needs help finding substance use treatment options.

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Payment assistance varies by state

The financial burden of substance use treatment varies from state to state, with a wide range in the number of programs that offer payment assistance. Nationally, fewer than half (45%) of facilities offer free or low-cost treatment options, but some states offer a much greater percentage than that. Many states with the most financial aid are clustered in the central U.S.; however, Hawai’i tops the list with nearly 85% of its substance use treatment facilities offering some assistance. Oklahoma, Wyoming, South Dakota, and Missouri round out the top five, with 62% to 75% of their state’s facilities providing help with the cost of treatment.

Surprisingly, some of the largest states offer the least assistance. Only about 2 in 5 facilities in California, for example, offer treatment for free or with minimal fees. That number is even lower in Florida, at 37%, and Minnesota is lower still, at just under 25%.

Survey data shows many commonalities among the five states with the highest percentage of facilities offering payment assistance. All five have markedly fewer clients in treatment than the states that offer less aid. Take Wyoming and South Dakota, for example, which each have less than 3,000 reported patients, compared to California, with over 87,000, and Florida, with over 55,000.

More patients mean resources must be stretched across more individuals, making less assistance available across the board.

The top five states also have more nonprofit organizations providing substance use treatment than the states with lower percentages of payment assistance. Hawai’i and Missouri have the highest proportion of nonprofit treatment facilities in the nation. More than 80% of the programs in both states are nonprofits, significantly higher than the national average of about 48%. Since nonprofit organizations are heavily funded through donations and fundraising, and excess funds must be reinvested into the organization rather than taken as profit, this money can be used to assist patients who may otherwise be unable to pay.

In addition to having more nonprofits, the top five states also receive more government funding than states that offer less assistance. Approximately 88% of facilities in Hawai’i receive such funding—nearly twice the amount California (44%) and Minnesota (40%) receive. This funding comes in various ways: At the federal level, the Substance Use Prevention, Treatment, and Recovery Services Block Grant provides funding for treatment and prevention programs targeting specific high-risk groups like pregnant women, mothers, and those who inject drugs. State and local government entities also allocate additional funds to help cover treatment for those without insurance.

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How to get help

With so many different substance use services available, on top of the practical and financial barriers to treatment access, it can be overwhelming to figure out where to begin when you or someone you know needs help.

For those with health insurance, the insurer can provide information about in-network treatment options and coverage. SAMHSA also offers a comprehensive website that is a good starting place for those with and without health insurance. It provides a facilities search feature and helps people find the best treatment facility for their needs. SAMHSA also provides a useful online list of questions to consider when selecting a treatment facility, such as cost, transportation, and how soon an opening is available in the program.

It is also important to understand the varying levels of care available. Depending on what type of substances are being used, at what intensity, and for how long, treatment needs can range from outpatient therapy (attended therapy once or multiple times per week while still living at home) to more intensive intervention provided short-term in an inpatient hospital or longer-term in a residential setting.

Individuals must also consider the potential need for detox before treatment. Withdrawals from alcohol and substances like benzodiazepines and opioids can be dangerous if not appropriately monitored by qualified medical professionals.

People with substance use disorders don’t have to sift through information and make difficult decisions alone, though. Having conversations with current doctors, treatment providers, and relying on friends and family can help tremendously when navigating the complicated world of substance use treatment.

Story editing by Natasja Sheriff Wells. Copy editing by Paris Close.

This story originally appeared on Health Centers Near Me and was produced and distributed in partnership with Stacker Studio.