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By Elise Chou
The opioid crisis continues to impact communities across the United States, claiming lives and creating deep challenges for individuals with opioid use disorder (OUD). Many people who need help struggle to access it, often due to barriers that can be social, economic, geographic, systemic, or emotional. Understanding these obstacles is essential for developing more effective solutions.
Even though medication-based treatment (MAT) for OUD is proven to reduce deaths and improve recovery, many people never receive care.
Systematic research shows that a wide range of barriers, beyond just physical access, keep many from entering treatment. This can include stigma, fear, lack of support, and negative attitudes toward treatment, which are pervasive across addict experiences.
Emotional and Psychological Barriers
Stigma and Internalized Shame
Stigma is one of the most reported emotional hurdles preventing people from seeking help.
Research published in the medical journal Drug Alcohol Dependency found that “stigma and fear” are major themes across different studies, closely tied with social and emotional obstacles like fear of judgment, internalized shame, and negative perceptions of treatment.
According to the Department of Veterans Affairs, individuals may avoid seeking help because attending an addiction clinic can make them feel labeled, judged, or stigmatized by family, friends, or health professionals. This emotional fear often reduces treatment engagement.
Fear of Withdrawal or Emotional Distress
Beyond stigma, people with OUD often worry about the emotional strain of changing their substance use patterns.
Qualitative research on treatment barriers highlights that individuals commonly mention fear of withdrawal symptoms, needing to “get things in order” personally before starting treatment, and anxiety about discussing their substance use as emotional obstacles to entering care.
According to the Journal of Substance Abuse and Treatment, some patients also associate opioid use with relief from emotional distress, so even the idea of stopping feels emotionally threatening, making them less ready to seek help.
Many people with OUD also struggle with co-occurring mental health issues like depression or anxiety. These conditions make it harder to engage in treatment, navigate systems, or stay motivated to seek help. Research consistently links mental health barriers with lower treatment uptake and higher dropout rates, especially when services aren’t coordinated.
Social and Interpersonal Barriers
Family and community support strongly influence whether a person seeks and continues treatment. According to the journal Drug and Alcohol Dependence, some people with OUD lack supportive relationships, or they live in environments where substance use is normalized. Other times, families experience stigma themselves, leading to isolation and discouragement from seeking care.
Another issue is housing instability, job insecurity, or criminal justice involvement can make it difficult to focus on treatment. These stresses not only interfere with logistics but also create emotional burdens that compete with time and energy needed for recovery.
In addition to emotional and social challenges, real-world structural problems like limited treatment availability, transportation and cost also complicate access.
Many areas lack enough providers who prescribe evidence-based medications like buprenorphine or methadone, and people may need to travel long distances for care.
Transportation issues and financial concerns make engaging consistently in treatment difficult. People seeking medications for opioid use disorder find lack of transportation and other logistical barriers are significant contributors to lower treatment access.
Rigid program requirements, long waitlists, or strict sobriety prerequisites before enrollment can emotionally discourage people from seeking help.
In Alameda County, California, local behavioral health services recognize many of these barriers and work to lower them, including:
- Alameda County Behavioral Health offers a free helpline (1-844-682-7215) to help people navigate treatment options and find referrals. This is a strategy aimed at reducing confusion and increasing access.
- Programs like the county’s ACCESS system provide centralized screening and referrals with licensed clinicians to support residents seeking mental health or substance use care.
- Local emergency departments, including those in the Alameda Health System, are implementing “low-barrier” opioid treatment approaches where patients can access medications like buprenorphine right in emergency settings, which research shows improves engagement and survival.
Even with these services, emotional and psychological barriers, like stigma, fear, and mental health challenges, remain key factors that influence whether individuals will reach out for and stick with treatment.
Getting treatment for opioid dependence isn’t just about clinics, prescriptions, or insurance coverage. Emotional barriers like stigma, fear of judgment, internalized shame, and mental health struggles are deeply intertwined with logistical hurdles and social stressors. Reducing these barriers involves not just expanding services but building empathetic, supportive communities, increasing awareness, and ensuring that treatment systems are welcoming and informed about the emotional realities people face.
This article was written as part of a program to educate youth and others about Alameda County’s opioid crisis, prevention and treatment options. The program is funded by the Alameda County Behavioral Health and the grant is administered by Three Valleys Community Foundation.
