Barriers to Quality Addiction Treatment: Why So Many People Go Untreated

Every year, millions of people who need addiction treatment fail to receive care for this condition. Many treatment barriers prevent people from accessing life-saving addiction treatment, such as lack of insurance, high cost of rehab, stigma, and lack of specialized care in their area.

Common Barriers to Drug and Alcohol Rehab

Addiction treatment barriers may vary from person to person, but common barriers include:[1],[2]

  • Geographic barriers, such as living in a rural area or a lack of local specialized care
  • Stigma
  • Financial barriers, such as high cost of treatment or lack of insurance
  • Lack of inclusive and culturally-responsive care
  • Dual diagnosis treatment availability
  • Time constraints and responsibilities
  • Fear of treatment or previous bad treatment experiences
  • Privacy concerns
  • Negative social support, such as losing friends if they go to treatment
  • Admission difficulties, such as being on a waiting list for a long time
  • False ideas about treatment, such as being able to detox on their own

However, many systemic and structural changes are aimed at increasing treatment access. For example, insurance companies are beginning to cover virtual addiction treatment and therapy for those who live in rural areas or who don’t have the flexibility to attend in-person care.

Moreover, rehab scholarships and financial assistance offered by facilities can help reduce the financial burden of attending treatment for low-income or uninsured individuals.

As for stigma, many influencers, advocates, and organizations are working hard to destigmatize addiction by educating people and encouraging them to use person-centered language. This can help people feel more empowered to seek out rehab.

Of course, many treatment barriers still exist and many people go without the treatment they need, but hopefully, these changes can work toward closing the treatment gap.

Geographical Barriers

One of the most common barriers to care is access to nearby treatment centers. Many people living in remote or rural areas must travel far to receive treatment, especially if they need specialized treatment such as dual diagnosis or population-specific treatment (e.g. veterans or LGBTQ+).

For example, low-population states have fewer drug rehab centers, which means they’re more spread out and harder for people to travel to. In 2016: [3]

  • Montana had just over 160 treatment centers.
  • Wyoming had 5,874 treatment programs.
  • Vermont had just over 60 rehab centers.

Meanwhile, California has nearly 2,400 drug and alcohol treatment facilities.[3]


Unfortunately, substance use disorder is a highly stigmatized condition that can prevent people from seeking drug or alcohol rehab. Stigma refers to negative biases and attitudes related to addiction, and in 2021, over 10% of people who needed addiction treatment didn’t receive it because they were afraid of negative attitudes from their friends or family.[4]

Even though substance addiction is a complex medical and psychiatric condition, research proves that individuals with this disorder face discrimination and stigma. This may be due to a lack of education surrounding substance use disorder as well as how it is treated.[4]

For instance, many individuals don’t know that addiction is the result of brain changes that make substance abuse compulsive and uncontrollable. Moreover, many risk factors—like genes, environment, and temperament—make certain people more susceptible to substance abuse and addiction than others. Still, many people still treat addiction as if it is a choice or a moral failure, blaming people with this condition as opposed to encouraging them to seek help.[4]

Stigmatizing addiction can actually cause addicted individuals to increase their drug or alcohol abuse due to shame and guilt, further reinforcing the cycle of substance misuse.[4]

Financial Barriers

Rehab can be rather expensive, especially in the case of inpatient addiction treatment, which can cost tens of thousands of dollars. Financial limitations can prevent people from accessing high-quality addiction care. Although health insurance can offset the cost of addiction treatment, many people are uninsured due to:

  • Change in family status
  • Job loss
  • Lack of employer insurance
  • Loss of Medicaid coverage
  • The high cost of health insurance

In the first three months of 2023, over 25 million people in the U.S. didn’t have health insurance.[5] Moreover, the following demographics lacked health insurance:[5]

  • 25% of Hispanic adults
  • 10.1% of Black, non-Hispanic adults
  • 6.9% of white, non-Hispanic adults
  • 2.7% of Asian, non-Hispanic adults

Lack of Inclusive Treatment

Many marginalized people, such as people of color and LGBTQ+ individuals, avoid seeking addiction treatment due to the lack of inclusive treatment in their area or in-network with their insurance.

A lack of inclusive treatment could look like a lack of diversity amongst staff and clients as well as a lack of culturally-responsive and culture-affirming treatment options. As of 2019, only 17% of psychologists were people of color and an alarming 83% were white.[6] If white, cisgender, or heterosexual providers are not providing culturally sensitive care to people of color or queer or transgender patients, they may actually exacerbate a client’s issues, causing them to feel stigmatized and shamed.

White treatment professionals can help create a racially inclusive practice by:

  • Choosing to practice anti-racism.
  • Educating themself on how different races and ethnicities may experience substance abuse and addiction.
  • Interrogating any assumptions or biases about race they may have.
  • Staying up-to-date with research related to culturally responsive treatment.
  • Employing a diverse treatment team that is welcoming and inclusive.
  • Recognizing how power, systemic racism, and privilege can impact the therapeutic relationship.

Meanwhile, cisgender providers can create a trans-inclusive environment by:

  • Using a person’s correct pronouns.
  • Ensuring access to gender-affirming care during addiction treatment.
  • Ensure paperwork is trans-inclusive.
  • Avoid asking invasive or inappropriate questions.
  • Engage in ongoing advocacy work.
  • Hang trans-inclusive signage, such as flags and gender-neutral bathrooms.
  • Acknowledge the trauma of previous non-inclusive treatment settings.
  • Listen and reflect the language the patient uses for themself.
  • Treat the patient like an expert on their own needs and identity.
  • Don’t rely on the patient to provide education.

Find Affordable and Accessible Treatment

If you are looking for affordable accessible treatment that meets your unique needs, you can use our treatment locator to find the right program for you. You can compare inpatient rehabs, outpatient rehabs, medical detox centers, and more.


  1. Rapp, R. C., Xu, J., Carr, C. A., Lane, D. T., Wang, J., & Carlson, R. (2006). Treatment barriers identified by substance abusers assessed at a centralized intake unit. Journal of substance abuse treatment30(3), 227–235.
  2. Farhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A., Pilevari, A., Mokri, A., Mohammadi, M. R., & Malekinejad, M. (2022). Barriers and Facilitators to Substance Use Disorder Treatment: An Overview of Systematic Reviews. Substance abuse: research and treatment16, 11782218221118462.
  3. Substance Abuse and Mental Health Services Administration. (2021). National Survey of Substance Abuse Treatment Services (N-SSATS): 2020 Data on Substance Abuse Treatment Facilities.
  4. Stigma and Discrimination. (June 2022). National Institute on Drug Abuse.
  5. U.S. Uninsured Rate Hits Record Low in First Quarter of 2023. (August 2023). Centers for Disease Control and Prevention.
  6. American Psychological Association Uses ACS Data to Identify Need for Mental Health Services, Education, and Training. (May 2021). United States Census Bureau.