Addiction Medicine: Closing the Gap between Science and Practice

want to quit.* 97 Another study found that
between eight and 16 percent of people who had
been assessed but had not entered treatment
cited some form of denial as the barrier.† 98

The most frequently-mentioned barrier to
accessing treatment for addiction involving
alcohol and drugs other than nicotine is not
being ready to stop using these substances.‡ 99 A
study of current smokers in Wisconsin found
that the main barriers to quitting that participants
reported were not being ready to stop smoking
because they enjoy it (79 percent), would crave
it (75 percent) or are afraid of losing the stress
relief associated with it (63 percent).^100

One national survey found that among
respondents who needed§ but did not receive
treatment, only 3.3 percent of those with
addiction involving alcohol, 8.3 percent of those
with addiction involving another drug
(excluding nicotine) and 12.4 percent of those
with addiction involving multiple substances
(excluding nicotine) perceived a need for
treatment.^101

Treatment providers also cite denial as the main
barrier to treatment access: CASA Columbia’s
survey of treatment providers in New York State
found that 85.5 percent of program directors and
84.9 percent of staff providers said that denial of
an addiction problem “very much” stands in the
way of people looking for needed addiction
treatment.^102

Misunderstanding of the disease of addiction
also is reflected in public policies and health
care practices that fail to integrate treatment for

• Respondents were asked to select two or three

reasons from a list read to them by the interviewer.
† Eight percent of respondents believed their “drug

use is not causing any problems” while 16.1 percent
believed they “could handle their drug use on their
own.”
‡ As reported in a national survey of individuals ages

12 and older who recognized they needed treatment,
made an effort to get treatment, but did not receive
treatment. These estimates are from combined
national data from 2006-2009.
§ Met clinical diagnostic criteria for addiction

involving alcohol or drugs other than nicotine.

all addictive substances including nicotine into

standard treatment protocols. (See Chapter X.)

Negative Public Attitudes and Behaviors Toward People with Addiction ................

Related to widespread misunderstanding of the

disease of addiction is the stigma attached to it--

the well documented, strong disapproval of or

discrimination against those with the disease--

and the fear of repercussions which prevent

people with addiction from getting help.^103

Although stigma is a subjective experience--

perceived disapproval by others and subsequent

embarrassment may or may not reflect a more

objective reality--there is a long history of

blaming and looking down on people with

addiction^104 rather than sympathizing with them

as we do for those with other health conditions.

The fear of disapproval or rejection can derive

from an individual’s own low self-esteem or

sense of shame about having addiction^ or it can

derive from a fear of abandonment by friends or

family because of the substance use itself, the

consequences that result or because of the

decision to pursue treatment.^105

Twenty-nine percent of the respondents to

CASA Columbia’s NABAS reported that the

main reason why people with substance-related

problems do not get the help they need is a fear

of social embarrassment or shame.^106 Another

national survey found that two-thirds (67

percent) of the public believe that a stigma exists

toward people who have been treated for

addiction involving alcohol or other drugs.** 107

A related study found that 80 percent of the

public believes that there is a stigma against

people with addiction involving alcohol and 51

percent believe this stigma is maintained even

after treatment or cessation of alcohol use.^108

Smokers also face a stigma, particularly in light

of increasing anti-smoking policies and

awareness of the health risks of smoking and

exposure to environmental tobacco smoke.^109

** This survey excluded addiction involving nicotine.

Stigma was defined for respondents as “something

that detracts from the character or reputation of a

person; a mark of disgrace.”