Why so few seek help – the alcohol and other drug treatment gap

Alcohol and other drug (AOD) use causes serious harms for many Australians, however a lot of people avoid or significantly delay seeking help.¹

In this article, we explore why this happens and what can be done to help close the treatment gap.

How many people delay or avoid seeking help for alcohol and other drug use?

It’s estimated that only around a third to almost half of Australians who would benefit from AOD treatment are actually accessing it.¹

This means about 500,000 people missed out on receiving help in 2023.¹

In fact, many people never get help.

Only 1 in 4 people who’ve been dependent on alcohol say they sought treatment.²

And those who do seek help often wait many years before they do so.

One study found that people wait an average of 8 years to seek treatment for their AOD dependence.²

Another estimated it takes an average of 18 years for someone with alcohol dependence to talk to a health professional.³

What gets in the way of getting help for alcohol and other drug use?

There are many reasons why people delay or avoid seeking help. These can be grouped into three types - personal, social and structural barriers.

Personal barriers

These are things that are driven by an individual’s knowledge, attitudes, skills or past experiences, for example:

• not understanding how harmful their use is - in one study only 1 in 5 people using AOD at risky levels thought they had a problem⁴
• self-stigma, which causes feelings of shame, guilt or embarrassment
• low motivation, confidence or skills to change behaviour
• not knowing that treatment works
• not knowing where to go for help
• past negative experiences with health services.^4-7

Social and cultural barriers

These barriers come from the way people are viewed or treated by others in society, or the culture they live in:

• stigma and discrimination, from family, employers or healthcare providers
• cultural beliefs that discourage asking for help
• low social support from family and friends
• attitudes within society that support or encourage AOD use.^5,6,8-10

Structural barriers

These are system-level issues that make it hard to access care, including:

• having caring responsibilities for others that make it hard to attend appointments
• not enough services or long waiting times
• services that are too expensive
• services that don’t support people with co-occurring mental health conditions
• services that don’t cater to different parts of the community, for example culturally appropriate care or treatment that can cater to people with disabilities
• fear of negative legal consequences or risks to employment.^5-7,11,12

These barriers can affect some groups more than others. For example, women, older people and people experiencing co-occurring conditions are less likely to seek treatment and often wait longer to do so.²

What makes someone more likely to seek help for alcohol and other drug use?

Many people will only seek help after a crisis – like losing a relationship, job, or home, being assaulted, overdosing or needing emergency treatment in hospital.^9,13

The people who are more likely to reach out for support earlier are often those who:

• feel hopeful about the future
• want to keep family relationships
• have positive attitudes to seeking help
• feel ready to make a change
• have good social support.^7,8,10,14

There are also some groups that are more likely to seek help than others. This includes men, young people and people first experiencing AOD issues as adults (aged 30 or over).²

A study found that people born between 1992 and 2005 are over four times more likely to seek treatment for a substance use dependence, than those born before 1972.² This may be because they have received more AOD education through schools and can more easily access online information on where and how to seek help.²

Do family and friends face barriers too?

Many family members and friends find it hard to get help when they’re worried about someone else’s AOD use.

In an Alcohol and Drug Foundation survey, about 1 in 3 people said it took them up to five years to look for help and support for a person they were concerned about.¹⁵

Almost 60% said they didn’t know how to talk to their friend or family member about their AOD use.¹⁵

Some of the main barriers included:

• not knowing how, where or who to ask for support
• feeling unsure about what kind of help to look for
• worrying about privacy, especially when using a phone or video service.¹⁵

How can we improve access to alcohol and other drug treatment?

The good news is that most of these barriers can be addressed.

But, given that there are so many, we need to act at several levels to help more people access AOD services when they need them.

At the individual level, people need better information to understand:

• the harms of AOD use
• where and how to seek help.¹⁶

Addressing social and cultural attitudes can be done by challenging harmful beliefs and reducing stigma. When people feel supported and cared for it is easier for them to recognise they’re experiencing harms and feel comfortable to ask for help.

Family and friends are a major source of support for people experiencing AOD-related harms. But, they also need better knowledge, skills, and confidence to support the recovery of those they care about.¹⁶

At the structural level, when someone is ready to seek help, they should be able to access services that are:

• welcoming to all genders, sexualities, cultures, abilities and age groups
• free from judgement and actively address stigma
• trauma and violence informed
• integrated with other services.^{1,5,11,14,17,18}

Even if all the above barriers were addressed, the gap between those who need help and who get it might still be too large for the health system to manage alone.

For this reason, we need to keep working on prevention. This means investing in evidence-based interventions and programs to reduce the likelihood of someone experiencing AOD harms. This includes improving access to housing, employment, social supports and keeping people out of the criminal justice system.¹⁹

More info

• Path2Help: intuitive online tool designed to help you find support and information tailored to the specific needs of someone you’re concerned about who uses alcohol and other drugs.
• Having the conversation: a resource with helpful tips on how to approach a conversation with your friend or family member about the impact of their alcohol and other drug use.
• Local Drug Action Team (LDAT) Program supports communities to work together to prevent and minimise AOD harms.
• Mental Health First Aid: a skills-based education program that equips people with the skills and confidence to recognise and respond to someone who may be experiencing a mental health or AOD problem or crisis.

This article has been reviewed by Mental Health First Aid International.