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Topics in Recovery: Obstacles to Treatment


If you’ve followed the news at all over the past three years, you know about the ongoing opioid crisis in the U.S. Many of the articles in the media and many of the speeches made by politicians and addiction experts regularly include the phrases obstacles to treatment or barriers to treatment in reference to organizing and implementing a public response to the crisis. You may understand what these phrases mean right away, and don’t need them explained. However, not everyone understands exactly what they mean in practical application.

We’ll explain.

First, the meanings of these words aren’t special or different, in this context, than in any other context in which they’re used. Treatment means getting help, and obstacle or barrier means something that stands in the way.

Therefore, in this context, a barrier or obstacle to treatment is something – anything – that prevents someone from receiving the help they need for an alcohol, substance use, or mental health disorder.

Unfortunately, in the U.S., there are significant barriers to treatment.

That’s one reason there’s what’s called a treatment gap. A treatment gap is the difference between the number of people who need treatment for an alcohol, substance use, or mental health disorder and the number of people who receive treatment for their disorder.

For example, according to the National Institute on Alcohol Abuse (NIAA), in 2017 over 623,000 adolescents met the criteria for an alcohol use disorder (AUD), but only around 30,000 received treatment.

That’s just over 5% – and that’s a problem.

That’s why we need to define and discuss obstacles and barriers to treatment: they’re keeping our teens from getting the help they need.

And that was just one example: significant treatment gaps exist for mental health and substance use disorders, as well.

The Obstacles

We’ll get straight into this, without any further preamble.

The Five Main Obstacles to Treatment

for People Living Alcohol, Drug, and Mental Health Problems

1. Stigma

For decades, the vast majority of our population – including mental health professionals – thought people living with mental health or addiction problems had those problems because of some sort of moral failing, personal weakness, or lack of willpower. This all began to change in the mid-90s, when the disease model of addiction and mental health first became accepted by the medical establishment. The disease model, in a nutshell, asserts that alcohol, substance use, and mental health disorders are chronic, relapsing diseases best treated with a holistic approach that includes individual and group therapy, behavioral/lifestyle changes, and medication. We now understand these addiction and mental health issues are not character flaws, but rather diseases that respond to specialized treatment.

2. Knowledge

This goes hand in glove with the first item on the list, stigma. Many people don’t fully understand this one important fact: treatment works. People can and do recover from substance use and mental health disorders. Millions have, and millions more will. The simple message that treatment works needs to be spread far and wide, and repeated as often as possible until people know and understand that if they – or someone they love – lives with mental health problems or addiction, they can get treatment. And that treatment can help them live a life of their choosing, rather than a life dictated by alcohol, drugs, or the symptoms of a mental health disorder.

3. Cost

This is a very real barrier, even to people with the knowledge that treatment works and the understanding that the stigma around treatment is based on misinformation and misunderstanding. The Affordable Care Act (ACA) mandated that insurers cover treatment for mental health and substance use disorders, and that has made an enormous difference. Yet there are still millions that don’t have the means to meet their deductibles, and millions more who have no insurance. There are public programs available to help those in the most significant need of assistance, but we still have a long way to go.

4. Location

For many people, finding a high-quality treatment facility nearby is difficult. While this is not always an issue for people entering residential treatment, it’s important to remember residential treatment is not feasible for everyone. Intensive Outpatient, Partial Hospitalization, and Outpatient treatment programs are all effective treatment options, but finding regular, reliable transportation to and from treatment continues to be an obstacle for people seeking treatment.

5. Willingness

This is, of course, the deciding factor for almost anyone living with addiction or mental health issues: making the personal choice to begin a recovery journey. If an individual does not want – really want, deep down – to enter recovery, then the chances are they will not be successful in recovery. This is clearly not an external barrier. This is an internal barrier that every person who wants treatment needs to face and overcome. For many people, once they understand and resolve items 1-4 on this list, they find that willingness, because treatment – possibly for the first time in their lives – seems both feasible and achievable.

Overcoming Obstacles: What You Can Do

The transformation of addiction and mental health treatment over the past twenty years is similar to the story most of us experience firsthand when we either enter treatment or start reading about treatment. We take a journey from vague notions, half-formed ideas, misunderstandings, and at times, simple ignorance – not through anyone’s fault, but through lack of knowledge – to an evidence-based, data-driven understanding of addiction and mental illness.

We’ve reached this place thanks to the work of researchers, clinicians, and people in recovery themselves.

While we don’t know everything about addiction or mental illness quite yet, what we’ve learned over the last twenty years is game-changing. We now understand that when we treat them as chronic illnesses rather than moral failings or character weaknesses, we can help people recover and live life on their own terms. When we offer people seeking help respect and compassion, we know they can learn to thrive. And finally, when we treat them in a manner that best suits their individual needs and unique histories – meaning we meet them where they are with what they need – we learn that they can take ownership of the situation and manage their own recoveries.

Therefore, what you can do to help remove the barriers and/or obstacles that remain is tell anyone who’s interested what you now know: treatment has come a long way, and for people living with addiction and mental illness, the future holds far more hope and promise than ever before.

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