Barriers to Substance Abuse Treatment

People may be reluctant to seek addiction treatment because of high treatment costs and low accessibility, denial of their substance use disorder, societal stigma and time constraints.
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The vast majority of people who need treatment for substance use disorders do not seek it. Several barriers can discourage someone from getting help, and many people are deterred by a combination of factors. But there is no good reason an addict should avoid rehab.

More than 20 million people battling addiction require treatment to recover. Some people can quit using alcohol or other drugs with the help of family, friends or support groups. However, people with substance use disorders need professional help to get better.


Mark, a student in recovery, explains the role of motivation in the decision to seek addiction treatment.

For them, the addiction is too severe or they are genetically predisposed in a way that makes it nearly impossible to quit without professional rehabilitation. Getting help for addiction isn’t easy, though. Withdrawal symptoms and cravings can discourage people from trying to quit. Many parts of society condemn trying drugs, leading many people to hide their addiction.

There are countless reasons why people who need addiction treatment avoid it.

According to the 2014 National Survey on Drug Use and Health, the most common reasons people who needed treatment did not seek help from 2011 to 2014 were:

  • 39 percent could not afford it or did not have health insurance.
  • 29 percent were not ready to stop using drugs.
  • 18 percent feared a negative opinion from neighbors or the community.
  • 17 percent feared it would affect work.
  • 14 percent did not know where to find help.
  • 8 percent did not think they needed help.

Robert Fishman of Advanced Recovery Systems discusses overcoming common barriers to treatment.

Sometimes people choose not to seek treatment for multiple reasons. For example, they may be afraid to tell their boss for fear of a negative reaction, and they think they can’t miss work or afford treatment in the first place.

Decades of research supports common themes for avoiding treatment: cost, denial, stigma, work and lack of awareness or knowledge. Psychological characteristics, lifestyles and environmental factors all contribute to the excuses.

Seeking treatment, but can’t get past those barriers?

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Treatment Cost

Treatment is expensive, and most people think they can’t afford to get help. In the past, insurance plans didn’t have to cover treatment for substance use disorders. However, the Affordable Care Act now requires insurance plans to cover mental health disorders, including substance use disorders.

IRS form 1095-A (Affordable Health Care Act)

The system isn’t perfect, though. Insurance plans don’t always cover inpatient residential care or treatment for more than 30 days. In general, experts recommend at least 90 days of inpatient rehab for severe cases of addiction.

There is hope, though. Many rehab facilities communicate with insurance providers to ensure the appropriate length and type of treatment for each patient is covered. Many rehab centers also determine cost based on a sliding scale determined by the patient’s income. Other centers receive funding from the government to lower the cost of rehab.

Perceived Absence of Problem

“I don’t have a problem” might be the most common response people with substance use disorders give for not attending rehab. The other might be “I can quit on my own.”

More than a third of people with substance use disorders think they don’t have a problem or they can quit on their own. In many cases, they have no motivation for quitting. They might not realize the damage their behavior has on their relationships, their work or other aspects of their lives.

Mature couple having relationship difficulties

Realizing treatment is necessary for recovery is a turning point in many lives. A 1996 study published in the Journal of Studies on Alcohol found that people who did seek treatment cited feeling as if they couldn’t solve the problem on their own as a key incentive for seeking help.


Almost one-fifth of people who don’t seek treatment say they fear what others would think if they went to rehab. The National Survey on Drug Use and Health identified the opinions of neighbors and community members as key factors, but the concern may be closer to home.

In a 2004 study published in the American Journal of Drug and Alcohol Abuse, injection drug users claimed that wanting to conceal their addiction from a spouse was the most common reason they avoided treatment.

Senior Adult Couple in Dispute

People with substance use disorders fear the judgment of society, friends and loved ones because addiction has become stigmatized. A 2014 Johns Hopkins study found Americans are more likely to have negative opinions of people with substance use disorders than other mental illnesses. But opinions are changing. Despite their worst fears, most family and friends of people with substance use disorders would prefer their loved one get better and not suffer in silence.

Time Conflict

Treatment and recovery take time. The more time and dedication a person devotes to getting better, the less likely a relapse. But most people battling addiction don’t want to take a 90-day break from their lives to attend rehab.

More than three-quarters of people with substance use disorders possess jobs.

More than three-quarters of people with substance use disorders possess jobs, and they often worry about losing their jobs while in treatment. Indeed, most inpatient facilities insist patients focus completely on treatment during rehab, but outpatient treatment can be effective and allow individuals in recovery to keep their jobs. Additionally, many employers support employees who seek treatment for addiction and will allow them to return to their jobs after rehab.

Another common time conflict is a lack of child care services. Though it can be difficult to leave work or to entrust child care to someone else, personal health is more important in the long run. Addiction and drug abuse can lead to unemployment and a loss of custody. Recovering from addiction is the best way to prevent that.

Poor Treatment Availability

Unfortunately, the demand for treatment is growing faster than the rehab industry. In rural areas, individuals with substance use disorders must often travel great distances to find a drug and alcohol rehab facility. In urban areas, many facilities have long waiting lists.

There are other options, though.

Support group discussion

Individuals on a waiting list can still visit their primary health care provider for medical advice. They can also join support groups and begin a 12-step program such as Alcoholics Anonymous or Narcotics Anonymous until they can enter a rehab facility.

There are plenty of reasons to avoid seeking substance abuse treatment, but you don’t have to hit rock bottom before asking for help. Treatment is more effective when people seek help before their addiction becomes severe, and recovery is easier if you start sooner rather than later.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Chris Elkins, MA
Senior Content Writer,
Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication.

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