Denial and Fear: Two Common Obstacles to Rehab

if you change nothing nothing will change
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In 2014, 21.5 million individuals in the U.S., 12 years old and older, had a substance use disorder according to SAMHSA’s National Survey on Drug Use and Health (NSDUH). [1] Sadly, nearly 90% of those who need alcohol and drug treatment in a specialized treatment center don’t receive it.

It’s difficult for many to understand why only a tenth of the people with addiction problems get the help they need. Is it due to denial? Lack of programs? Lack of financial resources to pay for treatment? Something else?

In order to understand this phenomenon, it’s important to consider some of the perceived obstacles that may be holding them back.

Following are several issues and misperceptions that allow so many who need treatment to talk themselves out of it.


Denial is one of the biggest obstacles when it comes to getting into treatment. Afterall, if a person doesn’t believe they have a problem they’re not going to seek help for it. Those closest see it – and have probably tried to address it countless times, often only to meet considerable resistance – but people with substance use disorders are often remarkably skilled at telling themselves myriad lies to avoid facing reality.

Denial can manifest in a multitude of ways. Some of the most common indicators of denial include statements such as:

  • “I can quite any time I want to.”
  • “I just drink socially (or use ‘recreationally’). You’re making a big deal out of nothing.”
  • “What’s wrong with having a couple beers (or glasses of wine, or shots of whiskey, or some weed, etc.) to wind down at the end of the day? It doesn’t mean I’m an addict.”
  • “Yes, I like to drink (or smoke weed, etc.). It’s my body and my life.”
  • “My drinking (or using) isn’t hurting anyone.”
  • “If I had a problem, I wouldn’t have a successful career (or be able to hold down a job this long, or take care of my kids, etc.).”

Perhaps you’ve heard statements like these from a loved one…or uttered similar lies yourself…if anyone dared broach the subject.

Denial is one of the biggest obstacles for many individuals with substance use disorders. The reality is that staying in denial really serves only to create and bolster the fragile illusion that everything’s fine and the individual is in control, when nothing is fine, and the substance is controlling the person while wreaking increasing havoc and destruction as time goes on.


Fear is another significant obstacle for those struggling with substance abuse and addiction. It may be fear of one specific thing or of several things. Common fears include:

Fear of not being able to cope / function / or survive without one’s substance of choice.

For someone with a substance use disorder, the idea of having to live without the alcohol and or drug(s) can elicit significant anxiety. It’s human nature to want to alleviate anxiety as quickly as possible. Many addicts desperately cling to self-denial and resist looking at the problem because the alternative is, quite frankly, terrifying to them. And of course, what better way to numb the discomfort than drinking, smoking, or snorting it away?

The reality is that using or drinking to escape provides only temporary relief, and the drugs or alcohol are hindering one’s ability to function optimally and find healthy ways to cope with life’s challenges.

Fear of damage to one’s reputation.

This fear is common for individuals with a substance use problem who are very high functioning in their daily life, successful in their career, or well-known in their community. The stigma that accompanies substance abuse and addiction is still very much alive, unfortunately. Many individuals are deeply afraid that going into treatment could have a devastating impact on their family, their livelihood, and their entire future.

While the fear isn’t entirely unfounded, the reality is the cat’s often already out of the bag – at least to those who are closest to the individual. One of the best ways to redeem a damaged reputation is to face the problem head on, be open and willing to receive help, and take the necessary steps to get one’s life on track. Doing so will not only garner the respect of others but also enable individuals to truly respect themselves.

Fear of family reaction. 

The fear of how partners, children, or other family members will react is a frequent obstacle to treatment. Sadly, some individuals face harsh criticism, judgement, and even ridicule from family members when they decide to seek treatment. The backlash may be due to the notion that having a family member admitting to substance abuse or addiction will bring shame to the entire family. Additionally, the cost and time involved in treatment may trigger anxiety about finances or lack of support.

The reality is that those closest to us are often thrilled and supportive when we finally get the help we need. When they’re not, though, it’s often due to underlying fears or resentment that’s been festering for a long time. Some may come around with time. Accepting what we can’t change is a key component of recovery. Sometimes cutting ties with those who wish to sabotage our efforts or refuse to be supportive is the healthiest thing we can do for ourselves. Is it easy?  No. But we can build new support systems, establish new friendships, and create new families over time.

Fear of what treatment entails.

Many individuals are truly afraid of getting into alcohol and drug treatment. Maybe they’ve had a bad experience at a treatment facility in the past – or know someone who has. Perhaps the thought of talking in a group setting puts knots in their stomach. The therapy process can be daunting to many as well. The thought of baring one’s soul and uncovering deep-seated issues – especially without being able to fall back on alcohol or drugs to numb the subsequent pain – may seem too overwhelming and downright frightening.

There may also be a fear of the detox process itself. Depending on the severity of the addiction and the type of substance, detox can be particularly physically uncomfortable. It can also be very emotionally draining.

The reality is that treatment, while certainly challenging at times, is often the only path to recovery. Yes, there will be some discomfort – it’s an inevitable part of the healing process and a necessary component for growth and change to occur. Group sessions and individual therapy are typically a critical part of alcohol and drug treatment. However, most individuals discover substantial value, particularly in the group process where they obtain support and understanding from peers, and realize their worst fears were unfounded.

Fear of relapse.

Almost everyone with a substance use disorder has a relapse story. Perhaps they’ve done all the hard work of going through treatment before and doing well for week, months, or even years – only to relapse at some point. The fear of relapse may also be due to having to return to an environment in which other family members are still using substances.

The reality is that a relapse, while certainly discouraging and extremely disappointing, isn’t the end of the world – even though it may feel that way at the time. Rather, it’s an opportunity to make lifestyle modifications to help ensure it doesn’t happen again. For many, this includes making difficult but beneficial changes in one’s living environment.

Fear of discrimination or losing one’s job.

This fear frequently creates reluctance to seek treatment. Most individuals don’t want to go into treatment only to find out, upon discharge, that their job has been given to someone else. Treatment may take 2 or 3 months in a residential or intensive outpatient setting. This makes it impossible or highly impractical to work, at least during the early stages. Many individuals avoid treatment because they’re convinced it will cost them their job or hinder them from getting hired.

The reality is there are laws in place that prevent employers from firing someone who goes into treatment for a substance use disorder. There are also laws that prevent them from being discriminated against when seeking employment. The FMLA (Family Medical Leave Act), which was passed in 1993, allows employees up to 12 weeks of medical leave which includes addiction treatment. The ADA (Americans with Disabilities Act) gives individuals in recovery protection from discrimination in the workplace. Drug addiction and alcoholism are both considered to be disabilities, and the ADA provides protection from discrimination by prospective employers. [2]

Fear of not being able to afford treatment.

One of the greatest obstacles to getting treatment is the fear of the cost and the belief that it’s simply not affordable or isn’t covered by insurance. Many individuals also worry about how they’ll pay their bills while in treatment.

Fortunately, more financial options and resources are available than most people realize.

For starters, some treatment facilities receive government funding to reduce costs. Many programs offer a sliding fee scale based on one’s income. Publicly funded treatment programs are available in most counties, cities, and states throughout the US. The ACA (Affordable Care Act), which has made health insurance available to millions of people who previously went without, mandates coverage for addiction treatment by health insurance providers.

Additional Options for Paying for Treatment

  • Scholarships offered by some treatment facilities
  • Angel Programs
  • GoFundMe and similar sites
  • Paid vacation time from one’s employer
  • Personal loans

Substance use treatment can be expensive, but the cost of not getting help is always substantially costlier – especially over a lifetime.

Humans have the amazing skill of talking ourselves out of getting the help we need, including help for health problems, financial issues, emotional challenges, relationship difficulties, and substance use disorders. It’s human nature to be resistant to change, because change almost always requires at least some degree of discomfort along the way – not to mention the fear of the unknown in terms of what change will bring.

If you know (or at least suspect) you need help for substance abuse or addiction – or those closest to you have been urging you to get help – perhaps it’s time to face your fears and set aside your excuses. Yes, it can seem daunting, scary, and perhaps even impossible at first. The good news, however, is that help is available, recovery is possible, and the benefits of sobriety are truly vast and outweigh all the negatives.



The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.