Experts Answer Your Questions on Substance Abuse and Treatment

Is "casual" use of scheduled substances possible without the risk of developing a problem?

According to SAMHSA’s annual national survey on drug use in 2022, 70.3 million Americans (24.9% of the population) over 12 years old reported using an illicit substance in the past year. In the same year, 48.7 million (17.3%) reported having a substance use disorder, with nearly half (27.2 million) reporting an alcohol use disorder instead of an illicit substance.^[1]

This data suggests that there is a wide margin of Americans who use substances without developing a substance use disorder, or who don’t believe they have a problem. This could be down to those who use substances recreationally or casually, such as only at parties or in certain settings, or those who think their use is not a cause for concern.

We asked the experts whether it is possible to have a relationship with substances of abuse without the risk of developing a disorder down the line. Here’s what they said:

Dr. Michelle Dees

The question commonly asked is if an individual can use drugs that have been labeled as having a high potential for misuse without eventually developing a substance use disorder. People need to know that while casual use does not always result in addiction, there are many things such as genetics, mental health, social environment, and the drug itself which can greatly increase the chances of this happening. ^[3]

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Medical advisor

Dr. Michelle Dees

PsychD

Dr. Michael Kane

Even with controlled substances, there is always a risk of developing a substance use disorder. Whether the usage is casual or not, repeated exposure to these substances can lead to physical and psychological dependency.

Many other factors can also contribute to the development of a use disorder, such as genetics, environment, and mental health. You never know when casual use can turn into something more serious, so it's important to always be mindful and cautious of your usage. ^[4]

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Medical advisor

Dr. Michael Kane

MD

Dr. Jordan Calabrese

Millions of people casually use substances like alcohol and marijuana. We refer to this as recreational use, and it can be done without fear of repercussion if being done so by adults in moderation. This might be true for most people, but it is not true for all.

If you are predisposed to having a substance use disorder, you may want to steer clear of even recreational use of what could be called “safe” substances. If substance use runs in your family, or if you have a personality that tends toward the addictive side, avoiding substances altogether is your safest bet. ^[5]

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Medical advisor

Dr. Jordan Calabrese

MD

Are certain individuals more likely to develop a substance use disorder?

We often think of substances themselves as the root cause of addiction. However, this is not always the case, and a wide spectrum of factors can influence substance use disorders.These can include:^[2] 

• Genetics
• Environmental factors
• Social factors
• Geographical location
• Traumatic events
• Pre-existing mental health conditions

We asked our experts to expand on what exactly makes someone more or less likely to become addicted to substance abuse.

Gary Tucker

Personal History: Individuals who have experienced trauma or stress or have a history of other mental health disorders are at a higher risk.

Genetics: Genetic predisposition can play a significant role in the development of SUD. Individuals with a family history of substance abuse are more likely to develop SUD themselves, as they may inherit certain genes that make them more susceptible to addiction.

Age: Initiating substance use at a young age increases the likelihood of developing SUD.

Cultural Factors: Cultural attitudes towards drug use and availability within a community can influence patterns of use.

Environmental Variables: Peer pressure, family dynamics, and economic status also play crucial roles. ^[6]

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Medical advisor

Gary Tucker

Licensed Psychotherapist

Dr. Michael Kane

Yes, some individuals may be more genetically or psychologically vulnerable to developing a substance use disorder. For example, those with a family history of addiction or who have experienced trauma may be more at risk. Additionally, individuals with mental health conditions may use substances as a coping mechanism, increasing their chances of developing a use disorder. ^[4]

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Medical advisor

Dr. Michael Kane

MD

Na'ilah Amaru

Anyone can experience substance use disorder. However, certain people may be more predisposed to developing a substance use disorder due to a combination of genetic, environmental, and psychological factors.

Genetic predispositions play a role if there's a family history of addiction or someone inherits traits that make them more susceptible to addictive behaviors.

Environmental factors such as exposure to substance use at an early age, peer pressure, trauma, and socioeconomic status can also contribute to the development of addiction. Also, underlying mental health conditions such as depression, anxiety, or trauma can increase the risk of substance abuse which is important to consider when exploring policy solutions to this issue. ^[7]

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Medical advisor

Na'ilah Amaru

Advocacy & Policy Strategist

How easy or difficult is it to get help for substance use disorders?

Despite substance addiction rehabilitation being one of the biggest industries in the United States, it is not always straightforward for people to access treatment. Financial, geographical, and logistical considerations can act as barriers to those seeking treatment. Another consideration is the range of treatment options available and knowing which one is right to treat the individual's condition.

Here’s what the experts had to say on accessing addiction treatment.

Gary Tucker

Access to help varies widely based on location, socioeconomic status, and the substance in question. While there has been significant progress in integrating addiction treatment into healthcare systems, challenges persist:

Availability of treatment centers and qualified professionals might be limited in certain areas.

Insurance coverage for addiction treatment can be variable, leaving some without necessary financial support.

Stigma around addiction can prevent individuals from seeking help. ^[6]

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Medical advisor

Gary Tucker

Licensed Psychotherapist

Dr. Michelle Dees

Getting treatment for addiction may be difficult or easy depending on where you are geographically situated and what resources are available locally as well as nationally whether it be through insurance coverage or personal circumstances like work commitments etc. However, even though treatments exist – there still remains barriers between those seeking help such as lack thereof. ^[3]

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Medical advisor

Dr. Michelle Dees

PsychD

Dr. Michael Kane

Access to treatment and resources for addiction can vary greatly depending on location, insurance coverage, and socioeconomic status. Unfortunately, many individuals may face barriers such as cost, lack of available treatment options, or stigma surrounding addiction that can make it difficult to get the help they need.

For instance, those without insurance may struggle to afford treatment, while others in rural or low-income areas may have limited access to facilities. This highlights the importance of addressing systemic issues and improving access to treatment for all individuals. ^[4]

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Medical advisor

Dr. Michael Kane

MD

Na'ilah Amaru

It depends on the person's circumstances. The level of difficulty or ease depends on geographical location, financial resources, social support networks, and availability of treatment services.

For example, in some areas, there are long waiting lists for treatment programs, limited resources for those without insurance, or stigma associated with seeking help for addiction, which makes it challenging for people to access the support they need. ^[7]

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Medical advisor

Na'ilah Amaru

Advocacy & Policy Strategist

Related: Racial Disparity in Drug Overdose Deaths in the U.S.

Is government and state funding enough to cope with the current addiction problem?

While many rehab facilities in the U.S. are run by for-profit organizations, some operate on state funding or via charitable donations. The latter is often the only choice for those who don’t have insurance or can’t access the finances to pay for treatment. As the name suggests, these organizations require government or state funding to operate, which may have an impact on their ability to facilitate treatment to all those who need it. With the opioid epidemic still raging, do state and government-funded rehabs have the capacity to deal with the issue?

Gary Tucker

Government and state funding towards addiction has increased in response to the opioid crisis and rising awareness of SUDs. However, the adequacy of these funds is subject to debate. Many advocates argue that while there has been an increase in funding, it still falls short of addressing the scale of the problem, especially considering the rising trends of addiction and the complexity of effective treatment, which often requires a multidisciplinary approach. ^[6]

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Medical advisor

Gary Tucker

Licensed Psychotherapist

Na'ilah Amaru

Budget constraints and competing political agendas impact the allocation of funds for addiction services from the government. As a result, there are gaps in services, lack of coverage for certain populations, or limited availability of evidence-based treatment options. ^[7]

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Medical advisor

Na'ilah Amaru

Advocacy & Policy Strategist

What are the barriers to getting treatment for those who need it?

Many potential barriers prevent those in need from getting treatment. Some of these relate to a person's environment, financial status, or available access to healthcare advice for their situation. For others, barriers can relate to their gender, race, or sexual orientation.

Gary Tucker

Primary barriers to treatment include financial constraints, lack of knowledge about available resources, fear of social stigma, and logistical issues such as transportation. Patient or body brokers exacerbate these obstacles by exploiting vulnerable individuals seeking treatment. They often redirect them to facilities offering subpar care that may pay the brokers for referrals, rather than guiding them toward effective, appropriate treatment options. ^[6]

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Medical advisor

Gary Tucker

Licensed Psychotherapist

Dr. Michelle Dees

For instance, the negative public attitude towards alcoholism and drug abuse is one barrier that prevents people from seeking help early enough or not seeking at all due to fear being stigmatized by family members, friends, colleagues, employers, and society in general Another barrier could be financial incapability to pay for private rehabilitation centers because of poverty lack of medical cover etc. ^[3]

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Medical advisor

Dr. Michelle Dees

PsychD

Dr. Michael Kane

As mentioned before, cost, limited access, and stigma can be significant barriers to receiving treatment for addiction. Other factors such as the fear of judgment, lack of knowledge about available resources, and personal beliefs may also prevent individuals from seeking help. In some cases, patients may also face obstacles such as long wait times or lack of support systems, making it harder for them to start their recovery journey. ^[4]

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Medical advisor

Dr. Michael Kane

MD

Na'ilah Amaru

Lack of access to transportation, stigma associated with addiction, fear of legal consequences, and inadequate support systems. Also important for policymakers to recognize systemic issues like healthcare access, discrimination, and lack of culturally competent services that can hinder receiving treatment. ^[7]

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Medical advisor

Na'ilah Amaru

Advocacy & Policy Strategist

Dr. Jordan Calabrese

Unfortunately, there are still many barriers to substance use treatment for those who need it. Socioeconomic status plays into this, with many people who need treatment, not having the resources to make it happen. More education is definitely needed in low-income areas about free services offered by the government or non-profit organizations.

They don’t get enough publicity and the most vulnerable people who need them the most often don’t know they exist. Governmental funding falls way short of being a solution to the problem, but it is a good place to start if you are looking for low-cost treatment resources.

There is still a societal stigma today too that prevents some from entering treatment. The fear of family, friends, or employers finding out that you have a problem causes many to delay seeking treatment. ^[5]

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Medical advisor

Dr. Jordan Calabrese

MD

What role do patient or "body" brokers play in creating barriers to treatment?

Patient or “body” brokers are individuals who persuade people to receive addiction treatment from facilities regardless of whether they are equipped to treat the person’s specific needs. Body brokers receive large commission payments per person they get signed into rehab, which can lead to the well-being of patients being put second to financial gain.

Dr. Michael Kane

Unfortunately, some of these brokers are more focused on the financial gain rather than the well-being of the patient. They may manipulate individuals into seeking treatment at certain facilities, regardless of their needs or preferences. This can be very dangerous and keep individuals from receiving the best care for their recovery. ^[4]

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Medical advisor

Dr. Michael Kane

MD

Na'ilah Amaru

Patient brokers profit from referring individuals to addiction treatment facilities can create barriers to treatment by prioritizing financial gain over the well-being of patients. Steering individuals towards certain facilities based on financial incentives rather than clinical needs does not serve the best interest of the patient. ^[7]

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Medical advisor

Na'ilah Amaru

Advocacy & Policy Strategist

Dr. Jordan Calabrese

Healthcare or body brokers are another barrier to treatment. Either the programs to which they are referring patients are paying such large kickbacks that they don’t have enough resources for the actual treatment, or scammers are taking advantage of those in need, referring them to treatment centers that are a sham. ^[5]

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Medical advisor

Dr. Jordan Calabrese

MD

What more can be done to help those who need it?

While tackling a substance use disorder is a personal journey, some things can be done on an individual and societal level to help those who need it. Here's what the experts suggest to help those in need.

Gary Tucker

Increased Funding and Insurance Coverage: Allocate more government funding to addiction services and expand insurance coverage for treatment.

Public Awareness Campaigns: Launch campaigns to educate the public about SUD, reduce stigma, and inform about treatment options.

Telehealth Services: Expand telehealth options to make treatment more accessible, especially for those in remote areas or with mobility issues. ^[6]

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Medical advisor

Gary Tucker

Licensed Psychotherapist

Dr. Michelle Dees

All said notwithstanding – one should remember that there is hope out here so don’t give up just yet. There are many more organizations than ever before that have dedicated their efforts towards assisting individuals to get into recovery. There are also helplines staffed with trained professionals who provide confidential advice over phone calls, text messages, emails, webchats, and face-to-face meetings. ^[3]

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Medical advisor

Dr. Michelle Dees

PsychD

Dr. Michael Kane

Education - One of the best ways to help those who need it is by educating the public on addiction, reducing stigma, and raising awareness of available resources for treatment. When more people are knowledgeable about addiction, it can lead to a more supportive and understanding community for those in recovery. It can also help those struggling with addiction to feel more comfortable seeking help.

Increased access to treatment - Governments and healthcare systems should work together to improve access to affordable treatment options for individuals with substance use disorders. This could include expanding insurance coverage, increasing funding for treatment facilities, and providing resources in rural or low-income areas.

Addressing underlying issues - In addition to treatment, it's important to address the underlying issues that may contribute to addiction. This could include improving access to mental health services, addressing trauma and adverse childhood experiences, and implementing preventative programs in schools. Stopping the cycle of addiction at its root can help prevent individuals from developing use disorders in the first place. ^[4]

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Medical advisor

Dr. Michael Kane

MD

Na'ilah Amaru

There's much that can be done to support those who need help, but three key points include;

Increasing funding for addiction treatment and prevention programs to ensure adequate resources are available.

Expanding outreach and education efforts to raise awareness about addiction, reducing stigma, and encouraging people to seek help early.

Fostering collaboration between government agencies, healthcare providers, community organizations, and advocacy groups to develop holistic approaches to addressing addiction and supporting recovery.

Substance abuse recovery can't be effective in patchworks or silos, and a more comprehensive, integrated approach is needed. ^[7]

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Medical advisor

Na'ilah Amaru

Advocacy & Policy Strategist

Dr. Jordan Calabrese

The best thing we can do to help people in need is to make sure that there is legitimate information about resources for the people who need it. We should be using public systems like the school or welfare systems to disseminate information to communities about where to turn to for help. It’s difficult enough to decide that you need help. Finding services that help you get the treatment you need shouldn’t be so difficult. ^[5]

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Medical advisor

Dr. Jordan Calabrese

MD

A final word from Recovered

As the experts have made clear, those trying to get help for a substance use disorder face many issues, and getting the right information is key to getting appropriate treatment. The important thing to remember is that there are always options and many organizations such as Recovered are dedicated to helping those who are struggling with substance abuse get the care they need.

Here are some more resources for substance abuse support:

Substance Abuse and Mental Health Services Administration (SAMHSA)

National Drug Helpline

National Center on Substance Abuse and Child Welfare