The latest National Survey on Drug Use and Health (NSDUH) for 2024 reports that 48.4 million people aged 12 or older had a Substance Use Disorder in the past year. Even more concerning, only 19.3% of those in need of treatment received care at a specialized facility, underscoring a significant care gap.
The pandemic put unprecedented stress on healthcare workers and led to a significant increase in substance abuse issues. Access to care was already limited in rural and underserved communities, and workforce shortages made it difficult for many individuals to get the support they needed. Data from the Kaiser Family Foundation revealed that opioid overdose deaths grew by 63% during the pandemic, and alcohol-induced deaths increased by 31%. Provisional data from the Centers for Disease Control and Prevention (CDC) shows that drug overdose fatalities reached a concerning high following 2020, emphasizing the need for immediate intervention.
Additionally, addiction is an under-treated condition because of the social stigma attached to it. Many believe substance abuse to be a behavioral choice, rather than a treatable chronic disease. Furthermore, individuals with substance use disorders are more likely to be on public health programs and often report that treatment is financially out of reach and that the systems themselves are too complex to navigate.
Amongst Medicaid enrollees with mental illness, about two-thirds have at least one other chronic condition, with substance use disorder (SUD) being the most common – a quarter of Medicaid enrollees with mental illness also have an SUD diagnosis. (Saunders et al, 2025)
Gaps in treatment leave millions without guidance, resources, and support necessary for recovery. Addressing the treatment gap requires innovative, community-based solutions. This is where community health workers (CHWs) play a crucial role in bridging the gap between healthcare systems and making a meaningful difference in the communities they serve.
Who Are Community Health Workers
CHWs are frontline, public health workers and trusted members of the community they serve. Their unique position allows them to connect with individuals with substance use disorder (SUD) to health services, programs, and resources that they may struggle to find on their own. Through outreach, community education, informal counseling, social support, and advocacy, CHWs not only link people to care but also help to build their health knowledge and self-sufficiency.
CHWs are known by a variety of titles, including:
- Community Health Advocate
- Community Health Outreach Worker
- Community Health Navigator
- Health Representative
- Maternal Child Health Worker
- Family Health Outreach Worker
- Recovery Coach
How CHWs Help Close the SUD Treatment Gap
The need for treatment has soared, but the treatment gap remains alarming. Among those with a diagnosed SUD, Black, Hispanic, and Asian Medicaid enrollees generally receive SUD treatment at lower rates than White enrollees (KFF).
CHWs can help bridge this treatment gap in the following ways:
- Address stigma and build trust by combating the public shame and internalized stigma that prevent many from seeking help. As trusted members of the community, CHWs can dispel myths surrounding addiction, emphasizing it as a treatable chronic disease, not a moral failing. Additionally, those CHWs with lived experience of SUD bring a unique understanding of the recovery journey, allowing them to offer empathy and insight that can strengthen trust, support engagement, and ultimately improve patient outcomes.
- Improve access to care with their extensive knowledge of the complex healthcare system that can be overwhelming for those struggling with SUD. Individuals struggling with substance use often have multifaceted needs that require a variety of medical care. CHWs can act as patient navigators, guiding individuals to critical resources for recovery and ensuring they are connected to the appropriate treatment and support services.
- Provide education and ongoing support by offering programs that discuss medication, managing medical conditions, adopting healthy behaviors, and other initiatives that empower individuals with SUD to take an active role in their health management. Additionally, CHWs offer informal counseling services through home visits and follow-up calls that provide consistency in their care, which is necessary for addressing setbacks and long-term recovery. They can also educate families and loved ones to help build a stronger network for those suffering from SUD.
- Reduce costs. Research indicates that CHW-supported programs are associated with reduced rehospitalizations, ED visits, and inpatient costs in low-socioeconomic communities, making CHW programs a cost-effective method to reduce healthcare services and improve recovery outcomes for individuals suffering from SUD.
Community Health Workers play a crucial role in bridging healthcare gaps by serving as patient advocates and navigators, providing education, and ultimately enhancing recovery outcomes. Their community-based approach can increase trust and ensure that individuals receive the care they need when they need it.
Strategies to Improve Integrating CHWs into Healthcare Systems
CHWs provide essential insights into patients struggling with SUD. Their unique position gives them an advantage over other healthcare professionals. Since they are on the ground working within the communities, they are well-positioned to address health and social needs surrounding SUD. CHWs play a vital role in bridging the gap between healthcare providers and communities. Here are some strategies to successfully integrate the benefits of CHWs into a healthcare system:
- Create partnerships with CHWs, especially those in rural and underserved communities.
- Provide comprehensive, specialized, and ongoing training that equips them with the necessary tools to perform their job effectively. Key areas include motivational interviewing, harm reduction, and trauma-informed care, which will help CHWs enhance their interactions with patients.
- Allow access to technology offerings such as EHRs so both the medical professional and CHW have access to patient care and history. That way, they can stay up-to-date on the health of their patients.
- Cultivate environments that value CHW contributions.
CHWs can provide significant value to any healthcare system. They build trust with patients since they are actively involved in their communities, and can create open communication between healthcare providers and patients through their active role. These skills can lead to improved adherence to treatment plans and better management of chronic diseases. Additionally, their involvement can lead to better health outcomes, reduced healthcare costs by preventing rehospitalizations, and encouraging regular follow-up care with primary care physicians.
Looking Forward
CHWs are vital to bridging the treatment gap; they use their extensive knowledge of the healthcare system and specialized training to connect patients with potential treatment options while also providing necessary emotional and logistical support. By empowering these workers and investing in community-based solutions, we can make meaningful progress in improving outcomes for those struggling with mental health and substance use disorders.