Why some may not seek substance use disorder treatment

For those unfamiliar with the realities and complexities of substance use disorders, the answer might seem straightforward: treatment.

Yet the numbers tell a different story. While 16.8% of the U.S. population (48.4 million people) dealt with at least one substance use disorder within the past year, only 3.5% received treatment. That stark gap raises an important question: Why don’t more people pursue the care they need?

5 common barriers to seeking substance use disorder treatment

Treatment can be an effective and beneficial step in the recovery journey—but there are also plenty of factors that can hold people back from getting help. Understanding those reasons is crucial for approaching substance use disorders with patience, empathy, and a lack of judgment.

1. They’re worried about stigma and shame

Entering a program or receiving care feels like an explicit admission that one’s substance use has become unmanageable. That’s a heavy reality to face, which triggers feelings of guilt, shame, and failure.

But their struggle is an even more daunting thing to admit to the outside world, particularly when substance use disorder still has a lot of stigma attached to it. Studies indicate that the level of stigma is higher toward people with substance use disorders than toward those with other psychiatric disorders or mental health issues.

There are potential real-world repercussions to worry about, too. Aside from being judged by others or being labeled as an “addict” for life (a term we highly recommend not using), they might also have concerns about practical outcomes like losing their job, housing, or custody of their children. For many, the perceived risks of finding help can feel harsher or more immediate than the consequences of leaving their substance use disorder(s) unaddressed.

2. They lack access

Treatment isn’t as readily accessible as you might think, especially in rural areas. Those outlying regions have limited networks of providers, leading to far lower treatment rates than in more urban settings.

Even when location isn’t an issue, high-quality recovery services are still alarmingly hard to come by. In one study, researchers found that only 54% of the residential addiction programs they contacted had a bed immediately available. Among facilities with waitlists, the average estimated time before a bed opened was 28 days. Unfortunately, that long wait time isn’t just frustrating—it decreases the likelihood that the person will follow through with treatment. According to a separate study, up to 50% of people will drop off a waiting list between the initial assessment and treatment entry.

Nearly one-third of states have less than 25 beds for substance use disorder services per 100,000 people. Even when people are ready and willing to take steps toward recovery, there’s simply not enough care available for them.
 

3. They’re not ready

For many people, the biggest barrier to reaching out for help is simply not feeling ready to do so. They may not believe their substance use is “that bad”—especially when behaviors like heavy drinking are normalized in certain social circles, industries, or work environments.

Studies show that 95% of adults with a substance use disorder did not pursue help simply because they didn’t believe they needed it, proving that denial is common.

Additionally, treatment can be an intimidating and overwhelming step to take. It involves reflecting on traumas or difficult moments, changing ingrained habits and behaviors, building a better or different support network, and navigating the very real risks of judgment and stigma. Understandably, some people just aren’t prepared to take all of that on.

4. They’re concerned about cost

Another harsh reality is that substance use treatment is expensive. For many people, it goes beyond being costly to being completely unaffordable. According to one study, the average daily cost of a recovery program was $878, with 48% of facilities requiring partial or full payment upfront.

Costs become more of a burden for people who need inpatient or residential programs. In the same study, the quoted cost of a month’s stay at a residential treatment facility was over $26,000. In separate research, the total average cost for residential addiction treatment was $42,500. That’s more money than most people have on hand or can reasonably borrow from their loved ones.

Insurance can help offset the price tag, but it’s difficult to find options that accept the right insurance—especially for people who have Medicaid, for example, as programs that accept Medicaid are frequently booked. In the same study, 57% of facilities that accepted Medicaid reported a waitlist compared to 19% of facilities that did not accept Medicaid.

5. They lack support

Even when someone is ready and able to seek help, they can face another critical obstacle: a real or perceived lack of support. Recovery isn’t something people usually can navigate alone, and having encouragement—from family, friends, or even an employer—can make a huge difference. Without it, taking that first step can feel impossible.

Some people simply don’t have anyone in their life pushing them toward care, and others may encounter active resistance or judgment. Employers may not offer the flexibility needed to attend appointments or participate in relevant programs, while friends or family may not know how to help or may unintentionally discourage them.

Distrust of healthcare systems can also play a role, especially for people who have had negative experiences in the past. In one smaller study, 40% of people who have used drugs said they avoided healthcare over a fear of mistreatment by providers.

For those who are isolated or lack guidance, even figuring out where to start can be overwhelming. Without someone to help explore options, provide emotional support, or simply reassure them that finding care is doable, many people delay or opt out of treatment entirely.
 
The challenges of accessing support for substance use are real—but they’re not insurmountable. By fostering an empathetic, understanding workplace culture, employers can make it easier for employees to start their journey. Carrum Health aids in this process by connecting people to high-quality care quickly—90% of our substance use disorder cases are referred within one day—and often at little to no cost, so you can help your workers take the step from intention to action.