When you see someone on the street, passed out, clutching a bottle in a paper bag \u2013 whether it\u2019s L.A. or Cleveland, New York or Topeka, Dallas or St. Paul - you wonder why they don\u2019t just get help. Ditto the reaction to the co-worker who keeps embarrassing himself at office parties, the constant drunk at bars, the relative who ruins every family gathering, or the loved one on their second or third DUI. Chances are you know someone with a drug and\/or alcohol problem, or someone who also has a mental health issue. Surely, you think, this person would want to get treatment. In all these scenarios, what are the reasons why people who need treatment don\u2019t get it? The answers may or may not surprise you. The fact of the matter is the situations are complex and diverse. There\u2019s no one single reason. Often, it\u2019s a combination of reasons. Or the reasons change over time. Still, with an estimated 20.8 million Americans aged 12 and older (8.3 percent of the population) in 2008 who needed treatment but did not receive it at a specialty facility, more than 95 percent (95.2) felt they didn\u2019t need it. This statistic comes from the 2008 National Survey on Drug Use and Health (NDSUH). Think of that number: 20.8 million people. That\u2019s huge, and it\u2019s indicative of the pervasive hold substance abuse has on individuals. The total statistic is 23.1 million people aged 12 and older who needed treatment for substance abuse in 2008. Only 2.3 million (0.98 percent of the population and 9.9 percent of those who needed treatment), actually received it at a specialty facility. Among the 20.8 million individuals who needed treatment but did not receive it, 3.7 percent felt they needed treatment but did not make an effort to get it and 1.1 percent felt they needed treatment, did make an effort to get it, but did not receive treatment. Let\u2019s break down the reasons for not getting treatment for substance abuse in each group. Substance abuse includes illicit drugs or alcohol.\r\nNeeded Treatment, Made No Effort\r\nAccording to NSDUH combined data from 2005-2008 surveys, there are five common reasons why people who felt they needed treatment for substance abuse but made no effort to get it: \u2022 Not ready to stop using (38.8 percent). \u2022 No health coverage\/could not afford cost (32.1 percent). \u2022 Possible negative effect on job (12.3 percent). \u2022 Not knowing where to go for treatment (12.9 percent). \u2022 Concern that receiving treatment might cause neighbors\/community to have negative opinion (11.8 percent).\r\nNeeded Treatment, Made an Effort\r\nIndividuals, who felt they needed treatment for substance abuse and did make an effort to get it, offered the following eight reasons (combined 2005-2008 NSDUH data) why they didn\u2019t receive treatment: \u2022 No health coverage and could not afford cost (27.4 percent). \u2022 Not ready to stop using (29.3 percent). \u2022 Able to handle problem without treatment (13.0 percent). \u2022 No transportation\/inconvenient (10.5 percent). \u2022 No program having type of treatment (8.3 percent). \u2022 Did not feel need for treatment at the time (8.2 percent). \u2022 Did not know where to go for treatment (8.1 percent). \u2022 Might cause neighbors\/community to have negative opinion (7.7 percent). \u2022 Might have negative effect on job (7.4 percent). Reasons People Did Not Receive Mental Health Services In 2008, according to the NSDUH, there were 10.6 million adults aged 18 and older (4.7 percent of the population) who reported an unmet need for mental health care. This figure includes 5.1 million who did not receive any mental health care during the past year. Those who did not receive treatment identified the following 10 barriers: \u2022 Could not afford cost (42.7 percent). \u2022 Could handle problem without treatment at the time (28.6 percent). \u2022 Did not know where to go for treatment (19.8 percent). \u2022 Did not have time (13.9 percent). \u2022 Fear of being committed\/have to take medicine (9.6 percent). \u2022 Concerned about confidentiality (8.5 percent). \u2022 Health insurance did not cover enough treatment (8.0 percent). \u2022 Might cause neighbors\/community to have negative opinion (7.7 percent). \u2022 Treatment would not help (7.2 percent). \u2022 Health insurance did not cover any treatment (7.2 percent).\r\nWhat About Those Who Felt They Didn\u2019t Need Treatment?\r\nWhat do we know about the 95.2 percent of persons needing treatment for substance use but didn\u2019t get it because they didn\u2019t see a need? What can be deduced about their reasoning beyond saying they didn\u2019t feel they needed it? Statistics don\u2019t help here, because it gets at more deep-rooted issues. Addiction professionals say there are several underlying reasons why persons who are addicted or dependent upon alcohol and\/or drugs don\u2019t seek treatment. These could include any, some, or all of the following 10 reasons: \u2022 Denial \u2013 The most common and initial reaction is that the addict refuses to accept that he or she has a problem with alcohol, drugs, or both. The person may be so entrenched in the drug habit that they deny its existence despite the facts. \u2022 Control \u2013 Male addicts, in particular, may find it difficult to admit there\u2019s a need for treatment due to issues of control. They need to feel in control of their own destiny and often are manipulative and controlling in their relationships with others. For an addict with control issues, seeking treatment is far down on the list. They\u2019d likely say they didn\u2019t have a problem or that they have everything under control. \u2022 Fear \u2013 It takes a lot of determination, motivation and courage to enter treatment. Many addicts are deterred by fear. They are afraid of the entire detoxification and withdrawal process, whether out of ignorance, past attempts on their own, or perceived dangers. They may be apprehensive about what the treatment program entails and not feel able to handle it. \u2022 Cut Off From Supply \u2013 Many addicts won\u2019t enter treatment because they won\u2019t have access to their supply of drugs or alcohol. Since drug and\/or alcohol treatment programs require sobriety, and many are residential and\/or do urine tests, addicts know there\u2019s no chance they can get high without getting caught. \u2022 Can\u2019t Give Up High \u2013 For many addicts, the biggest reason they don\u2019t go for treatment is that they can\u2019t give up the high. They\u2019re so wrapped up in how good they feel, so addicted to the high, that they can\u2019t envision living without it. Despite harm to physical and mental health, and serious consequences to family, relationships and career, addicts cling to what\u2019s known: the comfort of their addiction. \u2022 Treatment Won\u2019t Help \u2013 Some addicts feel they are beyond help. No treatment can possibly make a difference in their lives after years of being addicted to drugs and\/or alcohol. Those with co-occurring mental health issues can feel particularly hopeless. \u2022 Nobody Cares \u2013 After burning their bridges behind them, alienating family and friends during years of addiction, some addicts feel that there\u2019s no one left that cares whether they live or die. Since they have no one close, no one to support their efforts to get better, why bother? Lack of family or other support is a big issue not only in refusal to see a need for treatment but also among those who, after they do receive treatment, falter during recovery. \u2022 Stigma \u2013 Buried within a person\u2019s denial of need for treatment may be the stigma attached to \u201cgoing into rehab.\u201d Whether the person is a celebrity or a common laborer, society still treats addicts with a certain amount of contempt. At least, that\u2019s the fear among some addicts who would rather shoulder along with their addiction than admit they have a problem and seek help for it. \u2022 Hope the Problem will Resolve itself \u2013 Some addicts, who secretly know different, hope that the problem they currently have (or have had for some time) with drugs and\/or alcohol will simply resolve itself or go away. This form of self-delusion is akin to denial, but the accompanying blow to self-esteem when such a turnaround fails to occur plunges the addict into even deeper despair. \u2022 Want to Die \u2013 After years of abuse of alcohol and\/or drugs, having lost all hope, with no one to care, not believing treatment would be effective or seeing no reason to turn their lives around, some addicts continue their addiction in a deliberate attempt to end their lives. Why should they seek treatment when they don\u2019t want it? To an addict in the final stages of addiction, death may seem the only solution. While they may not overtly try to kill themselves, by continuing their addiction, they are slowly and inexorably seeking to end their lives.\r\nFinding Treatment For Substance Abuse\r\nArmed with many of the reasons why people who need treatment for substance abuse and\/or mental health issues, what can individuals do to be ready to help those in need should the occasion arise? One way is to research available alcohol or substance abuse treatment centers or mental health facilities.\r\nIf you are seeking addiction treatment for a loved one, you can call Promises Treatment Centers and speak with an intake specialist. If you are unable to travel to California or have a specific budget in mind for treatment, Promises offers referrals to some of the best treatment centers in the country.\r\nTreatment facility locators are available for drug and alcohol abuse through the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services (HHS). The SAMHSA Substance Abuse Treatment Facility Locator is a searchable directory of drug and alcohol treatment programs in the U.S. that treat alcoholism, alcohol use and drug abuse problems. More than 11,000 programs are in the database, including residential treatment centers, inpatient hospital and outpatient treatment programs for alcoholism and drug addiction. Individuals can call the SAMHSA National Helpline at 1-800-662-HELP (4357), available in English and Spanish, or TDD at 1-800-487-4889. This is a toll-free, national referral service for locating alcohol and drug abuse treatment programs. SAMHSA also operates a Mental Health Services Locator that provides comprehensive mental health services information and resources. The drop-down listing or map can drill down to state or U.S. territory-specific. In California, for example, the following information and resources are available: \u2022 Mental Health Facilities Locator \u2022 Mental Health Services Directory \u2022 Hispanic Youth Violence Prevention Services \u2022 State Resource Guide \u2022 State Suicide Prevention Programs \u2022 Substance Abuse Treatment Facility Locator \u2022 Center for Mental Health Services (CMHS) Grantees \u2022 State Statistics SAMHSA\u2019s Opioid Treatment Program Directory has information on medication-assisted treatment for substance abuse disorders. This site includes links to opioid treatment regulation, pharmacotherapy, co-morbidities (co-occurring disorders, AIDS, HIV, hepatitis and more), find treatment, patient resources and provider resources.\r\nWhat Else Can You Do?\r\nLearn as much as you can about drug and alcohol abuse and addiction and co-occurring mental health issues. Be ready and be supportive of the addict when he or she admits to their addiction and is willing to seek treatment. You may even want to arrange for an intervention to confront the addict and overcome his or her objections to seeking treatment. In the end, however, the addict must commit to seeking help and remain in the program for it to have any beneficial effect. No one but the addict can do this. Coercion, threats and promises only go so far. Each addict has his or her own tipping point as to when and how they\u2019ll seek treatment. The best thing anyone who cares for the addict can do is be ready when this occurs.