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8 Common Barriers to Addiction Treatment

Addiction is a not-so-quiet epidemic whose sinister reach has touched millions of unsuspecting lives. It’s estimated that 40 million Americans as young as 12 have a substance abuse problem, with nearly half meeting the criteria of a full-fledged substance abuse disorder. The numbers paint a bleak picture of the toll this is taking on our country. One out of every four deaths can be traced to drug use, both legal and illegal. Drug overdoses are one of this country’s leading causes of preventable deaths and in fact, are the number one cause of death for Americans under the age of 45.

Despite the widespread devastation that addiction has caused to families and even entire communities, an alarming majority of afflicted individuals never receive treatment for drug use disorders. According to a news release from the National Institute of Health, a whopping 75% of these individuals never receive treatment. Researchers fear that the consequences of untreated addiction will be just as deadly—if not more so—than the effects of COVID-19 in the past year and is an impending health crisis. Even drug users who manage to avoid overdosing can expect to lose as much as 18 years from their lifespan due to health complications or accidental injury due to drug use.

The question that remains then is why: why are so many millions of people who struggle with addiction failing to get the help they so clearly need? Despite government legislature and health officials being in agreement on the severity of this public health emergency and having spent over $35 billion of the federal budget for drug control in the past year, there are barriers to accessing treatment that government funding hasn’t been able to overcome.


Trying to pin down a reason why so many people never get help for their addiction is like trying to find an explanation as to why drug users turn to drugs in the first place: It’s complicated. Just as addiction is multifaceted and complex, so are the reasons why some never seek out treatment. The most obvious ones are that those who need the help aren’t sure where to go for help or, simply can’t afford it. However, there are a number of other factors, ranging from a personal unwillingness to lack of government infrastructure, that can also prevent people from receiving substance abuse treatment.


There’s quite a bit of truth in that old adage that the first step to getting better is admitting you have a problem in the first place. In 2019, of the nearly 19 million people with a substance use disorder, 95.7% didn’t feel that they needed treatment (of the remaining 4.3% who felt that they did, only one-fourth ever made some sort of an attempt to obtain treatment).

These individuals cited several reasons for rejecting treatment, with the most common being that they felt their drug use was under control or that they could handle it. Other reasonings relied on a lack of external input (“no one has told me I have a drug problem”); a denial that their drug use has any negative effects on their lives, or a belief that treatment wouldn’t have a positive impact on their lives.


In a similar vein, there are others who simply do not want to get treatment. The 2019 National Survey on Drug Use and Health conducted by SAMSHA found that 39.9% of people weren’t ready to stop using. For others, it was a fear of treatment either due to a previous negative experience or apprehension about what might happen in treatment. Embarrassment, shame, and fear of other patients in these facilities were also cited as reasons for the aversion.

One of the best ways to mitigate these sorts of fears are to do lots of research on different facilities and treatment programs in order to find a rehab that’s a good fit for you.


One of the most influential factors that affected whether or not a person struggling with addiction received help for their substance abuse was being unable to afford the cost of treatment. The largest subset of these individuals were those without insurance. However, others who did have insurance and cited financial concerns as their barrier to treatment reported that their health insurance that did not fully cover addiction treatment.

The majority of drug treatment as specialized facilities were paid for by private health insurance. Paying out of pockets with personal funds was the second-most common payment method, and was followed closely by some form of public assistance (other than Medicaid), Medicaid, Medicare, or a family member. Treatment paid for by the court’s military insurance, or employers made up the smallest source of payments.


Despite the wide availability of resources and information, not knowing where to go for treatment is the leading reason why people with a substance abuse disorder (and felt that they needed help) did not seek treatment. This issue is particularly pervasive in rural areas where resources, educational materials, and trained personnel are limited or where only a few facilities service a wide geographical area. This can lead to major disruptions between local, state, or national-level agencies.


Aside from the confusion that can shroud the initial search for treatment options, many have expressed difficulty with the rehab admissions process itself. Providers and patients find the process to be complex, which can make it difficult for authorities to connect individuals to the correct form of aid or cause delays in paperwork and processing. Some who make it so far as to attempt to enroll have been discouraged by the many steps required of the admission process.


Insufficient capacity is another factor that can inhibit proper treatment. This is especially problematic in rural areas as access to other intermediary sources of assistance (like a hospital or mental health facility) can also be few and far between. In urban settings, high demand for government-funded addiction treatment programs is a common hurdle for receiving treatment. Both situations can result in long waiting periods.


The logistics required for someone to be able to attend treatment are a simple but often overlooked barrier. Services such as medical detox can be lifesaving, but being away from their responsibilities for even just a few days at a time just isn’t feasible for them. Work responsibilities and childcare can make it difficult, if not impossible, for a person to take the time to devote to their substance abuse issue. The financial losses from either missing work or paying for childcare can also be unfeasible.

Further, transportation issues are another major factor that can add to the inconvenience of attending a rehab facility. Individuals who have been through the system are likely to have had their license revoked, and this can make them reliant on others for being taken to-and-from rehab. Or in the instance of many rural communities, substance abuse treatment facilities are far away. If they have responsibilities that make inpatient or partial hospitalization treatment impossible, this means attempting the commute for outpatient care is also out of the question.


Last but not least is the pervasive concern about what others will think and how it would impact the affected individual’s personal relationships. Many have cited either a lack of social support or negative social support as their reason why they are reluctant to attend treatment. About 17% of surveyed individuals were worried that it might affect their job, however, 18% were concerned with what the neighbors/their community would think of them.

Active discouragement from friends and family members, or worrying about repercussions from those loved ones, is also a powerful force that can prevent people from seeking the help they need. It just goes to show the importance of shedding light on the issues of drug use and addiction. Raising awareness promotes both sensitivity and sympathy which can go a long way towards easing fears of persecution or backlash.


Recognizing the barriers to accessing treatment is an important step in bridging gaps and helping millions get the help they need. However, the number of individuals who actively reject treatment shows that simply providing the resources for overcoming addiction isn’t enough to stop this health crisis. Motivation is the number one key factor that can affect whether addiction treatment will be successful or not and thus, convincing someone that their drug use is problematic is the primary hurdle our health system must overcome. Education, increasing public awareness, and acceptance play a major role in this task. If you have a loved one that has a substance abuse issue, saying something can be what makes the difference between their life and death.


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