Addiction Medicine: Closing the Gap between Science and Practice

Patients who do meet eligibility criteria and are
ready to enter treatment often face a long wait
for services--according to some estimates, up to
70 days^152 --due to limited treatment
availability.^153 This barrier can undermine an
individual’s fragile resolve to enter treatment.^154
Long waiting times may bias treatment entry in
favor of those most likely to succeed with
treatment,^155 as a longer wait time to enter a
program is associated with pretreatment
attrition.^156 One study found that the longer
patients have to wait between clinical
assessment and the first treatment session, the
less likely they are to complete subsequent
treatment sessions.^157 CASA Columbia’s survey
of treatment providers in New York State found
that a significant proportion of the respondents
said that long waiting lists “somewhat” (40.2
percent of program directors and 49.3 percent of
staff providers) or “very much” (22.0 percent of
program directors and 21.0 percent of staff
providers) stand in the way of people accessing
needed addiction treatment.^158

Insufficient Social Support ........................................................................................

A lack of social support can serve as a barrier to
treatment access. Individuals with addiction
may be discouraged openly by family or friends
from entering treatment or may have more subtle
fears that loved ones will think badly of them or
will be embarrassed or ashamed if they enter
treatment.^159 Even among those who may
otherwise seek treatment, continued substance
use in an addicted individual’s family or social
network can increase the risk of continued use,
reduce the likelihood of treatment entry and
derail treatment efforts.^160

Conflicting Time Commitments ................................................................................

Competing responsibilities and time
commitments related to one’s family and career
are common reasons for not seeking
treatment.^161 One study found that the
opportunity cost of a person’s time--including
both time spent traveling to non-residential
treatment programs and time spent in treatment
that otherwise would be spent on work or leisure
activities--is one of the main barriers to seeking
treatment.^162

Negative Perceptions of the Treatment Process.........................................................

Among those with addiction who accept that

they need to treat their disease are those who

believe they can manage it themselves, without

professional assistance.^163 Such a belief may

derive from a misperception of what symptoms

and what level of symptom severity constitute

the disease of addiction and require professional

assistance, or it may derive from the belief that

treatment simply is not effective and will not

help.^164 Some of this concern may be warranted

given the nature of the services offered.

(See Chapter X.)

Twenty percent of respondents to the NABAS

think that a main reason why people with

substance-related problems do not get the help

they need is that they do not believe that

treatment would help.^165 Treatment providers

see this as a barrier to treatment access as well:

CASA Columbia’s survey of treatment providers

in New York State found that a significant

proportion of the respondents said that the belief

that treatment does not work “somewhat” (63.9

percent of program directors and 59.0 percent of

staff providers) or “very much” (32.5 percent of

program directors and 31.7 percent of staff

providers) stands in the way of people looking

for needed addiction treatment.^166

Some individuals with addiction have negative

perceptions or a fear of treatment providers and

programs that may keep them from seeking and

accessing treatment.^167 These perceptions can

be based on an individual’s prior negative

experience in treatment, anticipation that the

treatment process will be unpleasant,

assumptions about the limited efficacy of

treatment or a general fear of what might happen

in treatment.^168

With regard to smoking cessation, there is a

prevalent belief among smokers that certain

interventions, particularly nicotine replacement

therapy (NRT), may not be safe.^169 One study

found that 66.0 percent of current and former

smokers expressed concerns about the safety of

NRT; those expressing concern were less likely