The Top Barriers to Addiction Treatment

A large majority of individuals who are struggling with addiction do not seek treatment. More often than not, barriers are hindering them from doing so.

When individuals with substance use disorders go into substance use treatment, it usually improves their rates of abstinence, relapse avoidance, and related behaviors. Unfortunately, only a small percentage of them do. According to the 2015 National Survey on Drug Use and Health (NSDUH), 21.7 million people ages 12 and older need substance use treatment, but only 2.3 million (less than 11%) receive it.

There seem to be barriers to avoiding drugs, barriers to substance use disorder treatment, even barriers to seeking treatment. According to some researchers, there are dozens of them.

What Are the Top Barriers to Addiction Treatment?

There have been multiple attempts to determine why individuals with substance use disorders aren’t getting help for drug abuse. They include as many as 100 different reasons or variations in several core categories. Most people claimed more than one.

One study divided the various reasons into seven categories:

1. Absence of problem: I use drugs or alcohol, but it’s not a problem.
2. Negative social support: What will my family, friends, and employers think?
3. Fear of treatment: Withdrawal is painful.
4. Privacy concerns: I can’t let anyone know.
5. Time conflict: I can’t neglect my family or job to seek treatment.
6. Poor treatment availability: There’s no rehab near me, at least one that I can afford.
7. Admission difficulty: There’s a long waiting list for treatment.

So, what was the primary problem impacting the effectiveness of drug treatment programs? According to the NSDUH, of the 19.4 million people who needed but did not seek treatment, more than 95% didn’t think that they needed treatment. Forty percent were not ready to stop using or didn’t want to do so. And 10% were concerned about what other people would think of them if they entered treatment.

Barriers to Treatment: Denial

So, the first barrier is people who do not see a problem, denial: they see nothing wrong with their substance use and want to keep using. In many cases, at least early on, no one else notices or recognizes it as a problem, which makes it easier for people to deceive themselves.

To be fair, most people don’t wake up and say, “I’ll get substance use rehab treatment today” if they don’t think they have a problem. It can be difficult for themselves or others to recognize there is a problem if they are meeting their work goals, fulfilling their social obligations, cleaning, and feeding themselves, and maybe fulfilling other responsibilities.

Any illicit or illegal substance use may pose a threat to one’s health or life, in the long term if not the short term, and it is better and easier to stop it as soon as possible. So, if you see something, say something.

Barriers to Treatment: Damage to Social Standing and Privacy

Another barrier is the stigma associated with substance use disorder, whether alcohol, prescription

medicines, illegal or illicit drugs. The federal government now recognizes that addiction is a disease, not a moral failing, but many still fear being labeled an addict, a drunk, a junkie. They fear what their employers, their landlords, their friends, even their families will say or do. They could lose their jobs, their homes, their lives.

Because rehab is so associated with the 12 steps method created by Alcoholics Anonymous, people may resist seeking help because they don’t want to stand up in front of a large group and say, “My name is Blank, and I’m an alcoholic” or “drug addict.”

They may just be shy, too, or embarrassed, even in front of strangers in group therapy or one-on-one with a therapist.

In some cases, their friends and family may discourage treatment for their own reasons. They may not “believe” in rehab for religious or political reasons, or they may be afraid of stigma by association, among other barriers to recovery from addiction.

The damage only becomes worse if people don’t seek help. Besides, many employers will keep employees who find help before it becomes a problem on the job. It is often cheaper to rehabilitate sick workers than to replace them.

Barriers to Treatment: Fear of Treatment

Some people also or primarily fear the substance use treatment itself: withdrawal pains, loss of drug-induced euphoria, or rehab conditions. They may picture a snake pit-type mental health asylum hellhole where people are tied down to chairs or beds, sweating out poison for days or weeks.

The modern rehab is much different. Withdrawal is often mitigated by tapering off of the primary drug, sometimes with a substitute medication-assisted treatment (MAT) such as methadone or Suboxone (a combination of buprenorphine and naloxone).

Another MAT, naltrexone in the form of the once-monthly injection Vivitrol, prevents the effects of opioids, so should not be used during withdrawal.

Rehab settings, too, are nicer than those earlier Hollywood depictions. They tend more to dormitories or sometimes luxury resorts.

There are true horror stories of rehabs that don’t treat clients, only to warehouse them, and somewhere they feed their clients’ addictions so they can continue to milk their insurance or families. Research can usually weed those out.

Barriers to Treatment: Time Conflict

Like other necessary chores—dentist appointments, oil changes—sometimes we avoid rehab because of the time it takes. Whether seven days or 30 days or 90 days, that’s a large block of time. Even if its outpatient or in-home, rehab involves more than not using drugs. It means rewiring your brain, learning new ways to cope with pain or mental health issues. That takes work and time.

Waiting until their bodies or lives break down because of substance use disorder will take time, too, if they are lucky. The increasing substitution of drugs such as fentanyl and carfentanil for less powerful opioids has led to a large increase in the number of overdoses and deaths associated with illicit drug use.

Barriers to Treatment: Admission Difficulty

Like other medical services, there are not enough addiction treatment facilities or specialists to go around. If everybody who needs rehab for substance use disorder went looking for it, there wouldn’t be enough doctors, centers, or treatment center beds. Certainly not qualified ones.

Some areas are underserved. Not every small town has even one substance use disorder treatment center. Many people are unwilling or unable to travel out of town for treatment, whether they believe they need it or not.

It becomes harder when you have special requirements or needs: nonreligious or non-12-step, MAT, or dual diagnosis (a diagnosis of a substance use disorder problem and a mental illness), or alternative therapies.

There was one additional, related category that the researchers didn’t quite manage to cover.

Barriers to Treatment: Cost

Both the Barriers Questionnaire and the Allen Barriers to Treatment Instrument (ABTI) include the inability to pay among the possible reasons that individuals can’t obtain treatment. Rehab is expensive, especially the best rehabs, especially if people’s insurance policies don’t cover it adequately.

Since the Patient Protection and Affordable Care Act (ACA) added mental health and substance use disorder coverage to its list of 10 essential health benefits, it has been more difficult for insurers to avoid covering it. Some small employers are exempt, however, and changes to federal law in 2017 make it easier to obtain plans without all the essentials.

Of all the barriers to treatment, this is the most senseless. With or without universal health care, society should pay for rehab because it saves money. Misuse of alcohol, prescription medicines, and illicit and illegal drugs costs society “more than $400 billion annually in crime, health, and lost productivity,” according to the U.S. surgeon general. However, every dollar spent on treatment for SUD “saves $4 in health care costs and $7 in criminal justice costs.”

It is believed that opening one additional substance use disorder treatment facility in a county may reduce rates of drug-induced deaths and associated crimes, saving approximately $700,000 per year. Spending an additional $1.6 billion on treatment could reduce crime-related expenses by several billion dollars.

More can, should, and must be done to knock down the barriers to substance use disorder and the barriers to recovery.

References

• drugabuse.gov  – How Effective is Drug Addiction Treatment? (Principles of Drug Addiction Treatment: A Research-Based Guide. Third Edition)
• samhsa.gov – America’s Need for and Receipt of Substance Use Treatment In 2015
• ncbi.nlm.nih.gov – Treatment Barriers Identified by Substance Use Disorderrs Assessed at a Centralized Intake Unit
• samhsa.gov – Allen Barriers to Treatment Instrument
• casaa.unm.edu – The Barriers Questionnaire
• healthcare.gov  – Mental Health & Substance Use Disorder Coverage
• healthcare.gov – What Marketplace health insurance plans cover
• npr.org – Trump Is Trying Hard to Thwart Obamacare. How’s That Going?
• addiction.surgeongeneral.gov – Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health
• aspe.hhs.gov – Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment