Obstacles to Recovery

Each year millions of people who need treatment for an alcohol or drug abuse or dependency do not receive it.

The National Survey on Drug Use and Health (NSDUH), published in 2013, approximated that 22.7 million Americans aged 12 and older needed specialized treatment for an alcohol or illicit drug abuse issue. Only 10.9 percent, or 2.5 million, of those needing treatment actually received it in a specialized facility, leaving 20.2 million people without the proper treatment they needed.

Many barriers exist that prevent those who need treatment from seeking or receiving the required care. The Substance Abuse and Mental Health Services Administration (SAMHSA), which publishes the NSDUH report, used combined data from 2010-2013 to attempt to discover why the disparity exists. Those who recognized that they needed treatment gave the following reasons for not receiving it:

  • Not prepared to stop using: 40.3 percent
  • No health coverage and financial difficulties covering the cost of care: 31.4 percent
  • Potential implications in the workplace: 10.7 percent
  • Possible negative perceptions by friends, neighbors and/or the community: 10.1 percent
  • Unsure where to obtain treatment: 9.2 percent
  • Programs not having type of treatment needed: 8 percent

Of those struggling with substance abuse who perceived the need for treatment and actively sought it out, additional or different obstacles existed as well. Treatment was still not received after making an effort to obtain it for the following reasons:

  • Cost-prohibitive or no health coverage: 37.3 percent
  • Not ready to abstain from using: 24.5 percent
  • Unsure where to obtain treatment: 9 percent
  • Health insurance did not cover costs or treatment: 8.2 percent
  • Treatment was inconvenient or no transportation was available: 8 percent

Addiction is a chronic brain disease that requires specialized treatment in order to maintain successful recovery. Regardless of your individual circumstances, you can overcome these barriers and receive the right treatment to help you reach your goals for a healthy and more balanced life.


Recognition that a problem exists may be the first obstacle standing in the way of sobriety. Denial, or the idea that treatment is either unnecessary or ineffectual, may be an internal barrier preventing substance abusers from seeking help. Addicts spend excessive amounts of time obtaining, abusing, and recovering from their substance of choice. They may pull away from friends and family members, stop engaging in activities they used to enjoy, and be less productive with work, family and school obligations.

Chronic drug or alcohol abuse makes chemical changes in the reward pathways of the brain, interfering with the natural motivation system. In short, abusing substances may numb emotions and pain sensations and increase happy feelings for a time. When the drug is removed, however, withdrawal symptoms may occur, leaving addicts feeling depressed, agitated, irritable and even physically ill. The brain has likely developed a physical and psychological attachment or dependence to the substance, and addicts are not often keen to break this bond.

If an addict is unable to find the initial internal drive to seek treatment, assistance may be necessary. Families and loved ones may use the services of an interventionist in order to help a loved one recognize the need to enter a treatment program.

The idea that an addict must first hit rock bottom, or make the choice to seek out treatment on their own, is not entirely correct. Often, it takes the help of an outside motivator in order to realize that treatment is necessary; however, this does not detract from the efficacy of treatment once received. Outside influences that push substance users toward treatment can come in the form of a health concern, deterioration of family and interpersonal relationships, loss of a job, or even legal troubles.

The National Institute on Drug Abuse (NIDA) estimates that court-mandated treatment or legal pressure may actually increase retention rates and successful outcomes. Once in treatment, either mandatory, coerced, or voluntary, substance abusers often find the internal motivation necessary to continue and make a successful recovery.

Finances and/or Insurance Issues

Substance abuse treatment is not generally free, and it is often perceived as cost-prohibitive. Many times, this is a misconception, as more and more health insurance companies and policies cover at least some form of substance abuse treatment. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires insurance issuers and group health plans to provide coverage for substance abuse disorders in much the same manner that they cover surgical or other medical procedures. Treatment or visits should not be limited, or deductibles or co-pays financially inaccessible under the MHPAEA.

President Obama’s Affordable Care Act (ACA) also makes health insurance more accessible to more people and includes substance abuse treatment as one of the essential benefits under the 10 elements of health care coverage. As of January 1, 2014, all health insurance coverage must include substance abuse treatment, as reported by CBS New York. You may not be denied coverage for a preexisting substance abuse issue, and substance abuse screening is now considered preventative care and must be covered under the ACA.

Health insurance plans will vary in the type of treatment covered, however, so be sure to check your coverage carefully to determine what is covered and what the requirements may be. Some may require a referral from your primary care doctor, while others may expect you to enter into an outpatient treatment program and be unsuccessful before covering a residential program, for example.

Most states, cities or counties also provide free and publically funded substance abuse treatment for those who cannot afford health insurance or who are covered under Medicaid. Self-help and 12-Step support groups are also generally free of charge and an important part of the recovery process. Some treatment facilities may offer various payment methods as well, including payment on a sliding scale or scholarships based on eligibility requirements.

Even though drug or alcohol treatment may be expensive, it may actually save you money over the course of time. Addiction is a financial burden in itself, costing addicts money to continue, money in health care issues related to the substance abuse, potential loss of funds due to a lack of workplace production, and even financial burdens due to legal actions resulting from substance abuse. Addiction may cost you up to seven times more than the cost of a successful treatment program in the long run, as reported by Everyday Health. Seeking treatment may actually be more cost-effective, therefore, than not receiving the proper care.

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