Barriers to Getting Well

Because of stigma, shame and failures in today’s approach to treatment, millions of Americans continue to suffer from addiction.

The disease afflicts 22 million Americans, yet nearly 90% of those who are sick get no treatment in a given year. Those who do manage to receive treatment are highly likely to suffer a reoccurrence of symptoms. In fact, less than 10% will remain well one year after a treatment episode.

These dismal facts underscore the failure in our current approach to treating and managing this disease.  

Systemic Problems 
  • Treatment for the disease of addiction is largely disconnected from mainstream health care.
  • Physicians are insufficiently trained to identify or diagnose the disease of addiction, and they do not know what to do with patients suffering from symptoms of the illness.
  • The medical field has primarily focused on treating the secondary and tertiary complications of the disease, rather than the disease itself.
  • Most treatment for addiction is provided by a broad range of practitioners largely exempt from medical standards.
  • The treatment system is almost universally based on an acute care rather than chronic disease model.  The acute model of care, which doesn’t match the chronic nature of addiction, is crisis-oriented, time-limited, fragmented and episodic.
  • There is inadequate accountability for most addiction treatment providers.
  • Credential requirements vary widely by state and often have little to do with the effectiveness of treatment or measurable outcomes.
  • Quality assurance standards tend to focus more on administration rather than treatment outcomes.
  • Addiction treatment providers, facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards.
Ineffective Treatment
  • The vast majority of today’s treatment facilities do not provide evidence-based care. 
  • The predominant acute care model means that the service relationship is extremely time-limited, without the extended monitoring and support needed to successfully manage this chronic disease.
  • The emphasis in most treatment programs is on symptom elimination of a single primary problem (i.e., not using the substance), rather than overall disease management.
  • Addiction counselors, who make up the largest share of treatment providers, provide care for patients with a medical disease but are not required to have any medical training. 
  • There are no consistent quality standards or requirements for measuring and demonstrating treatment outcomes.
  • Many providers base treatment on outmoded approaches and thinking. For example, relapse is seen as failure of the individual rather than a shortcoming of the treatment approach.
  • Care is not patient-centered or individualized for the person suffering from the disease. For example, most programs require patients to adhere to a single approach rather than recognize multiple pathways to wellness.
 Stigma and Shame

Public attitudes about addiction and those who suffer from it also create significant barriers to getting well. The shame, stigma and discrimination attached to this disease prevent many people from seeking help and make the process of staying healthy extremely challenging. 

Stigma is linked to myths and misconceptions about what causes addiction and the people who suffer from it. In addition, stigmatizing language we’ve inherited around addiction perpetuates bias by conveying the idea that someone is to blame for their addiction, is a bad person and should be punished.

This language is so punitive and prejudicial that people and families whose lives are being torn apart by addiction are literally scared to death to affix these labels to themselves and don’t seek help.  

  • About one-third of Americans continue to see addiction as a sign of lack of willpower or self-control.
  • 63% of the general public see addiction as a personal or moral weakness and only 34% see it primarily as a health problem.
  • 60% of those with an alcohol problem would not seek help because of fear of stigma.


Inside Rehab by Anne Fletcher
Clean by David Sheff
Addiction Medicine: Closing the Gap between Science and Practice, CASA at Columbia University
Recovery Management and Recovery-Oriented Systems of Care, William White