Original Research J Clin Psychiatry June 2026

County-Level Variation in Substance Use Disorder Service Utilization by Insurance Payers and Self-Pay in the United States

Full Article Read the complete peer-reviewed article in J Clin Psychiatry. Clinical Summary Most people who need substance use disorder treatment still do not receive it, and where a patient lives may strongly shape whether care is accessed through Medicaid, private insurance, or self-pay. This study quantifies how sharply SUD service use varies across US counties and shows that insurance coverage—especially the local uninsured rate—is one of the strongest markers of whether treatment is actually used. FAQ How much substance use disorder care was paid for by Medicaid, private insurance, and self-pay in this study? 10 questions
Key Takeaways Self-pay represented 43.0% of SUD service utilizations but only 5.1% of SUD service expenditures, indicating that a large share of SUD care is occurring through lower-cost ambulatory care and prescriptions rather than more intensive covered services. 6 takeaways Clinical Guide How can clinicians and program leaders use county-level payer patterns to identify where substance use disorder service access is most constrained? 7 steps
Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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