There are a number of reasons why an addict won’t get help for a drug problem, but they usually come down to one thing: fear.
For the uninitiated, that may seem ridiculous: After all, addicts put themselves in situations that threaten their physical health and well-being all the time. Overdose, for example, is always a danger for those who use drugs, and more than 93,000 people died of one in 2020 — a 30% increase over 2019, according to The Washington Post.
There’s the danger of incarceration: According to the Prison Policy Initiative, “21% of sentenced people in state prisons and local jails are incarcerated for crimes committed to obtain drugs or money for drugs. Almost 40% of people locked up for property crimes and 14% of those incarcerated for violent crimes reported that they had committed their most serious offense for drug-related reasons. If these figures hold for the entire prison and jail population, that means over 473,000 people are behind bars for seeking drugs.”
And then there’s always the threat of physical harm. As the Drug Enforcement Administration points out in its highlight of 2020 statistics, “violent crime rates showed a disturbing increase, with murder, aggravated assault, and other violent crimes on the rise. Drug trafficking is a known contributor to violent crimes in America.”
Given those very real threats, then, why do addicts refuse to consider addiction treatment as an alternative to them? What are some of the reasons why an addict won’t get help for a drug problem? Let’s take a look.
Why an Addict Won’t Get Help: ‘I’m Fine’
There’s a saying in recovery: “Denial is not a river in Egypt.” Addicts and alcoholics are usually the last ones to recognize that their use is a problem, and when confronted, one of the biggest reasons why an addict won’t get help is because he or she insists that they don’t have one.
“Ongoing denial of addiction is something that may even continue well into the first few days or weeks of a drug and alcohol rehab program,” writes Kelsey Brown in a 2018 article for the website PsychCentral. “It’s not always an easy thing for addicted individuals to overcome, but it can be very damaging if it is allowed to fester. Denial distorts reality.
“When a person denies their addiction, they are attempting to manipulate their loved ones into believing the same. This may even lead loved ones to question their own perception of the situation or doubt that what they believe is a real problem. This distortion of reality is the addict’s way of ignoring the problem and as a result, the destruction and chaos continue.”
There’s another saying in recovery as well: “Fine stands for F’ed up, Insecure, Neurotic and Emotional,” so if an addict says he or she is “fine,” chances are they mean what they say … but not in the way that they think.
Why an Addict Won’t Get Help: ‘It’s Not My Fault’
Addicts are master manipulators, as Kathleen O’Keefe, writing for the website Patheos, points out: “This is part of the smoke and mirror of deflection and avoidance associated with addiction … the person with the problem can make you question your motives, judgment and sanity in order to shift the attention away from them, so they do not have to take responsibility for behavior that controls them … their god is their addiction. You become the bad guy for not accepting or ignoring the disruptive behavior.”
One of the reasons why an addict won’t get help is because they feel like, given the right circumstances, they can “fix” their problems. If the cause of those problems is always an external circumstance, then the blame is constantly shifting, and the “right” circumstances become the ideal scenario in which change will take place. However, that’s never the case, as Patti Cotton writes for the newspaper The Press Enterprise: “Placing blame is one of the excuses an addict uses to justify substance abuse. They often believe family and friends are just trying to make their lives worse, and it is usually nearly impossible to convince them otherwise. Besides the denial they exhibit when they explain why they drink or use, drugs and alcohol can actually cause or heighten feelings of paranoia.”
‘I Can Quit Whenever I Want’
One of the biggest reasons why an addict won’t get help is the (mistaken) belief that he or she is able to control the use of drugs. Unfortunately, for those who have progressed from experimentation to casual use to full-time substance abuse, quitting on their is easier said than done.
“A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.”
What does that disruption look like? According to the National Institute of Health, the brain rewards healthy behaviors (physical fitness, eating, sex) by “switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviors. In contrast, when you’re in danger, a healthy brain pushes your body to react quickly with fear or alarm, so you’ll get out of harm’s way. If you’re tempted by something questionable — like eating ice cream before dinner or buying things you can’t afford — the front regions of your brain can help you decide if the consequences are worth the actions.”
However, addiction hijacks the pleasure and reward circuits of the brain, so that “more” becomes a giant, flashing neon sign that burns brighter than everything else. At the same time, drugs and alcohol can trip the “danger” circuits, which then tell you that without those substances, you and your body are under duress. And “to add to that, repeated use of drugs can damage the essential decision-making center at the front of the brain. This area, known as the prefrontal cortex, is the very region that should help you recognize the harms of using addictive substances.”
In other words — the brain is physically compromised, and the ability to quit becomes severely impaired, no matter what the individual might otherwise claim.
Shame and Stigma
Even if an individual knows he or she needs help for a drug problem, one of the reasons why an addict won’t get help is because addiction is still so heavily stigmatized. According to ABC News, “the stigma and shame associated with drug and alcohol dependence have helped to build an invisible wall that can isolate addicts and their loved ones in times of deep crisis. Common misconceptions as to both the causes of addiction and the ways in which it can be successfully (or not) treated add to the fog of mystery and confusion.”
A great many illnesses have been stigmatized over the years — HIV and AIDS, for example — but few have persisted under such negative optics as addiction. As the National Institute on Drug Abuse points out, “little progress has been made in removing the stigma around substance use disorders. People with addiction continue to be blamed for their disease. Even though medicine long ago reached a consensus that addiction is a complex brain disorder with behavioral components, the public and even many in healthcare and the justice system continue to view it as a result of moral weakness and flawed character.”
Those who know they need help are often reluctant to seek it because of that stigma, and for many, suffering in silence yet free from judgment is preferable to admitting to a problem that they themselves believe to be a moral failure or a character flaw. Sean Fogler, writing for STAT News, puts it this way: “Stigma violates the right of people with addictions to be human, strips us of our dignity, and says to us that we have no value. It evokes feelings of shame so deep they are hard to know unless you’ve experienced them. This isn’t the kind of shame that guides us or tells us we’ve made a mistake. It’s toxic shame, the shame that tells us we are the mistake — something those of us with this disease come to believe. It tells us that we’re never safe and keeps us silent, hiding and alone, unvalued members of the human tribe. And that’s how many of us with this disease die: hopeless, spiritually empty, and alone.”
Why an Addict Won’t Get Help: Fear of Detox
A great many addicts whose problems have crossed the threshold into the territory of physical dependence know all too well how agonizing withdrawal symptoms can be. According to the National Institute of Health’s Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, “Withdrawal management (WM) refers to the medical and psychological care of patients who are experiencing withdrawal symptoms as a result of ceasing or reducing use of their drug of dependence … withdrawal symptoms vary according to the drug of dependence and severity of dependence, but often include nausea, vomiting, diarrhea, anxiety and insomnia.”
From a clinical perspective, that may sound uncomfortable but not debilitating. However, those brain pathways that tell an addict he or she is in danger because they’re not using drugs? Those aren’t just activated; they’re blaring like the incoming missile klaxons on a naval warship, and the addict feels a deep and abiding terror about what’s happening to them. Elvis Rosado detailed his personal experiences to Kaiser Health News, in which he described going through opioid withdrawal while in jail: “The first few hours were gradual, like the onset of the flu, he recalled. But then he started sweating and shaking, his heart raced and he started throwing up. About 12 hours in, Rosado said, he was reminiscing about how pleasant food poisoning was compared to this. He said his stomach cramps felt like ‘having Freddy Krueger inside you trying to rip his way out.’ Rosado couldn’t sleep; he lay on the cold floor, shivering. ‘I had days where I felt like I wished I was dead,’ he said … over the next week, the intense symptoms slowly subsided. He was exhausted, depressed, irritable and sore.”
One of the reasons why an addict won’t get help is because they’re under the mistaken impression that detox is just that: withdrawal without any comfort or support, but the reality, of course, is that’s the furthest thing from the truth when it comes to a drug and alcohol treatment facility. Safe medical detox programs use comfort medication and clinical protocols to manage withdrawal symptoms, keeping patients as comfortable as possible while they’re slowly weaned off of drugs … but still the misconception remains.
What Can You Do?
If you’re a family member, loved one, employer or friend of someone who needs drug and alcohol treatment yet refuses to get help, you may have heard one or all of these reasons. There are methods you can use, however, to talk to someone about alcoholism or addiction, from simple conversations to an intervention with a concerned group of individuals.
The goal, of course, is to encourage the individual to get the help they need, and to slowly overcome the reasons why an addict won’t get help for his or her problems. It’s not an easy process, but then again, addiction is a complex disease that requires patience and understanding above all else. As Mara Tyler, writing for the publication Healthline, points out, “Trying to help someone with an addiction can be a long, challenging, and painful process. Unlike someone with a physical health condition, such as cancer, a person with an addiction might not recognize the true danger of their illness or understand the risks of not treating it.
“It’s important to remember that they are ultimately responsible for their own recovery. Typically, they must first recognize that they have an addictive disorder. Then, they must be ready and willing to address their addiction before their recovery can even begin. Setting realistic expectations and boundaries can help you provide support, while protecting your own well-being.”
Remember: You’re broaching the subject out of concern, not to be combative. Regardless of your opinions, and the information laid out here about how the reasons why an addict won’t get help are simply excuses, you can’t get someone sober who isn’t ready. But you can open doors for them to do so when they are, simply by acknowledging the problem and letting them know that you want to help.