The opioid crisis in the US continues to get worse every year. In 2017, more than 70,000 Americans died of drug overdoses and nearly 48,000 of those deaths involved opioids. [https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates] Much of the response by insurance companies and local, state, and federal government policy has been to increase the number of treatment options and to make treatment more affordable. Despite these efforts, overdose deaths have continued to rise. As of 2016, only about 11 percent of people who needed help for addiction actually got it. [https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FFR2-2016/NSDUH-DR-FFR2-2016.htm] With more treatment options than ever, why do so few people actually get help?
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Here are 7 Reasons People Don’t Get Help for Addiction
1. They aren’t ready to quit.
The majority of people who need help for addiction but don’t seek it–about 38 percent, according to the National Survey on Drug Use and Health [link above]–simply aren’t ready to quit. This can be terribly frustrating for friends and family who can see the obvious damage drugs and alcohol are doing to their loved one but the person with the substance use disorder often sees things differently. They may even be aware of some of the negative effects of their substance use but, for now at least, they feel like the benefits outweigh the consequences. If someone feels his substance use is, on balance, a positive thing in his life, it’s hard to convince him to change.
2. They don’t think they need it.
Related to the point above, many people don’t seek help because they don’t think they need help. They may feel like their substance use is not that bad, especially if their friends drink and use drugs more heavily. They may recognize that their substance use is a problem but they may feel like they can address it on their own.
3. They don’t think they can afford it.
Another big chunk of people who don’t seek help for addiction–about 27 percent–either don’t have health insurance or don’t believe they can afford treatment. While most insurers now cover addiction treatment to some degree, that’s clearly no help to people who don’t have insurance. The good news is that even without insurance, addiction treatment is more affordable than ever. In 2018, Congress passed the bipartisan SUPPORT Act, which is a wide-ranging law that, among other things, eases restrictions on federal funding for addiction treatment. [https://www.congress.gov/bill/115th-congress/house-bill/6] That means Medicare and Medicaid will now pay for more treatment options. There may also be state and local programs to help pay for treatment. The important thing is to contact treatment centers and ask about payment options even if you think you can’t afford it.
4. They don’t know where to get treatment.
With so many options for treatment, the choice of where to get treatment can be overwhelming. Perhaps that is why about 20 percent of people who don’t seek treatment say it’s because they don’t know where to get treatment. Perhaps the best thing to do enlist the help of either a doctor, therapist, or supportive friend. Some good signs to look for in a treatment center include qualified staff, high staff-to-client ratio, evidence-based methods, clean and comfortable facilities, an individualized approach, and strong follow-up care to help you transition back to daily life. Your options will further be narrowed by which programs accept your insurance and which programs have openings.
5. They fear the stigma of addiction.
While we’ve made a lot of progress in our attitudes toward addiction in recent years, especially as the opioid crisis has touched more and more lives, we still have a way to go. According to an AP-NORC poll from 2018 found that 53 percent of Americans now see addiction as a disease that requires medical treatment. However, the same poll also found some discouraging results: fewer than 20 percent of Americans are willing to associate with someone with a substance use disorder as a friend, neighbor, or coworker. [http://www.apnorc.org/news-media/Pages/AP-NORC-Poll-Most-Americans-see-drug-addiction-as-a-disease.aspx] It’s no wonder that so many people are reluctant to be open about their substance use issues. However, without treatment, a substance use disorder is likely to get worse until it comes out anyway.
6. They’re afraid of professional consequences.
It can be hard to take time off work to get treatment for addiction. Not only is there loss of income but many people have ongoing obligations that are difficult to hand off. What’s more, many people fear being fired for asking for so much time off. These are all valid concerns which are mitigated somewhat by the Family Medical Leave Act or FMLA. Under the FMLA, you can take up to 12 weeks off for addiction treatment and your job and healthcare benefits will still be secure. [https://www.law.cornell.edu/cfr/text/29/825.119] This doesn’t address the other concerns but it’s worth considering that a substance use disorder will eventually have a negative effect on your work. It’s in your best interest as well as your employer’s to get help before addiction has a serious impact on your work.
7. They have practical obstacles.
Taking 90 days or more out of your life to get addiction treatment is a big decision and sometimes there are very real practical objections. A big one, especially for women, is that they have kids to take care of. Other objections include professional responsibilities, as noted above, and financial responsibilities. Insurance might pay for your treatment but it won’t pay your mortgage while you’re in treatment. These are very real concerns but these problems can often be solved either by enlisting the help of friends and family or by finding treatment options that work with your specific circumstances.