January 19, 2024

Uneven Access and High Costs: The State of Residential Addiction Treatment for Adolescents

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A new study shows that 23 states in the U.S. don't have treatment facilities that accept Medicaid, limiting an at-risk population's access to treatment.

The Bottom Line

Residential addiction treatment centers for adolescents are costly and unevenly distributed across the U.S., with more than 60% of facilities that accept Medicaid already at capacity. With fentanyl leading to a rising overdose crisis in this age group, access to all treatment pathways possible will be essential.


Though substance use among U.S. teens has remained largely unchanged since 2019, it has also become much more dangerous. Due to the overwhelming presence of illicit fentanyl in the drug supply, drug overdose deaths among adolescents are steadily increasing.

Residential treatment centers are voluntary live-in facilities where patients can generally access addiction treatment alongside therapy and be closely monitored by care teams. They’re one option for teens using drugs, especially those with a more complex medical or psychiatric comorbidities. They’re also helpful options for teens who have an unstable or challenging home environment.

Identifying a treatment center that isn’t financially burdensome and provides evidence-based options is often a cumbersome task for families or loved ones, who must with find and evaluate options amid a crisis. Prior to this study, little information and guidance existed for youth-specific addiction residential treatment.

Study Objective

To assess the state of residential treatment facilities for adolescents, including the number of beds available, treatment offerings, and cost.

The Details

Researchers from Boston Medical Center (BMC), Oregon Health and Science University, PeaceHealth and Yale University used a “secret shopper” study, adapted from a prior study of adult residential treatment facilities, to call residential treatment centers while role-playing as the aunt or uncle of a 16-year-old child with a recent nonfatal fentanyl overdose. They asked about admission, treatment practices, and cost, including whether they accepted uninsured adolescents or Medicaid, as well as how families or typically covered the cost.

To obtain the list of treatment facilities within the 50 states and Washington D.C., the research team primarily used the Substance Abuse and Mental Health Services Administration’s treatment locator.


Researchers identified 160 residential treatment facilities in the U.S. and D.C. that confirmed they supported children under 18. There was wide geographic variability. Just over half of the facilities accepted Medicaid (1 in 5 for-profit treatment centers accepted Medicaid, while 4 in 5 nonprofit did). For people paying out of pocket, the average daily cost of treatment was roughly $1,211 at for-profit treatment centers, as compared with $395 at nonprofits. Close to half of all facilities required some kind of up-front cost if the client was self-paying, with the average for-profit price tag ringing in at $34,729. A staggering 23 states did not have a residential treatment center that accepted Medicaid and only 7 states had an open bed that day and offered buprenorphine, an evidence-based medication for opioid use disorder.

Pull Quote

“The lack of affordable, evidence-based adolescent residential treatment capacity for large geographic areas of the U.S. emphasizes the need to expand timely access to addiction treatment for adolescents through both residential and outpatient programs. … Both residential and outpatient treatment settings must address the complex challenges that adolescents bring to substance use disorder treatment.”


King C, Beetham T, Smith N, Englander H, Brown P, Hadland S, Bagley S, Wright O, Korthuis T, and Cook R (2024). “Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists And High Costs” Health Affairs.

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