The Revolving Door We Call Addiction Treatment

One in six people age 12 and older battled a substance use disorder (SUD) in 2023. That’s what the data says. But I’d argue it’s much more prevalent than that.

The numbers don’t include the one in ten kids and teens living with a parent who has alcohol use disorder—or the partners, siblings, friends, and coworkers impacted along the way. Substance use rarely confines itself to the person drinking or using. It ripples outward, affecting relationships, households, workplaces, and entire communities.

So while the data says one thing, lived experience tells a different story. It feels a lot more like one in one.

But our healthcare systems weren’t built to handle how widespread addiction is—or how complex recovery can be. We treat addiction today like an acute crisis, not a chronic condition. Care is designed around getting someone through detoxification—which alone can be a significant hurdle—but it is rarely structured to keep them well long term. That gap is where the revolving door begins.

Help Is Hard to Find, Even When You’re Ready

For anyone who has tried to help a loved one find treatment, you know how quickly hope can turn into overwhelm. Getting into care isn’t as simple as making a call. It’s a confusing, high-stakes journey of repeated phone calls, outdated provider lists, insurance hurdles, and treatment programs that are either at capacity, not covered, or not the right fit. Or worse, the first ad someone sees leads them to a program that sounds promising, but isn’t grounded in proven, evidence-based care. All of it unfolds while someone you care about is in crisis, and time suddenly feels like the most precious and limited resource you have.

Substance use treatment adds another layer of complexity, where care options vary widely, in setting and in intensity, ranging from withdrawal management and residential programs to partial hospitalization, intensive outpatient care, and peer support. Yet there’s rarely anyone guiding families or patients through these options, let alone helping them understand what level of care is clinically appropriate. Many are left unsure where to begin. In a recent Substance Abuse and Mental Health Services Administration (SAMHSA) report, nearly 40% of people who knew they needed treatment but didn’t receive it said they didn’t know how or where to get it.

Provider shortages are also a growing issue, with more than a third of the U.S. population living in areas with significant mental health professional shortages. Providers with specialized training in substance use disorders are even harder to find. That means that even when someone is ready to seek help, the odds of finding a provider with the right expertise, at the right time, are slim. When care is delayed or mismatched, symptoms can intensify, motivation fades, and people are more likely to drop out of care.

We Treat the Crisis, Then We Discharge

Getting into treatment should be the turning point, but for too many people, it falls short. Most programs are built to manage the immediate risks of SUD: withdrawal, overdose, or psychiatric symptoms like suicidality or psychosis. While these are all critical parts of initial intervention, they’re only one piece of the puzzle.

For many, substance use isn’t a standalone issue; it’s closely intertwined with co-occurring mental health conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), or bipolar disorder. According to recent data, nearly half of all adults with a substance use disorder are also managing a mental health condition. These conditions are not parallel challenges; they are clinically linked and can be central to the onset, persistence, and escalation of substance use.

Yet most treatment settings still separate the two, offering siloed care that addresses only part of what someone is experiencing. An individual might receive addiction treatment in one facility while their depression or trauma goes unaddressed, or they may be referred to a separate mental health provider with no coordination, communication, or shared treatment plan between the two. In some cases, they are denied care altogether. It’s not uncommon for specialty mental health clinics to exclude people with SUD from being in their care.

This lack of integration has serious implications for care continuity and long-term outcomes. When mental health conditions go unaddressed and there’s no clinically appropriate outpatient plan in place, progress made in treatment is easily undermined, and people return home without the support they need to maintain recovery.

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They’re discharged with referrals but no clear transition plan; given a diagnosis but left without a coordinated outpatient pathway to continue their care. Without meaningful support, people are forced to navigate a disconnected system, playing the role of care coordinator as they juggle therapists, psychiatrists, primary care doctors, and specialists with little guidance. When early challenges like cravings, stress, or unresolved mental health symptoms resurface, the risk of SUD recurrence increases, which explains why more than one in three people reported alcohol or drug use within 30 days of leaving residential treatment—on average, just 10 days after discharge.

This is unacceptable.

SUD Care Needs an Integrated Approach

Treatment readiness is a critical window in active addiction. The care system should be designed to move people forward from that point.

But too often, we miss it. Not everyone will speak up the moment they’re ready, and if we’re not screening people regularly, we may never know. Screening creates a way in. To get to the people who are ready, but don’t say the words out loud. It’s a simple, powerful way to meet people where they are.

And when someone is ready, the care system needs to be just as ready to respond. Many people delay or avoid care because they believe treatment means only inpatient stays or withdrawal management. But recovery doesn’t have to start with the highest level of care. For some, the right entry point may be medication management to reduce symptoms, intensive outpatient treatment, or trauma-informed therapy. One size doesn’t fit all, and no one should be overlooked just because their starting point doesn’t match where the system expects them to be.

Above all else, recovery requires integration. Substance use and mental health conditions need to be treated together, as each issue exacerbates the other and leads to worsening use and symptoms. Without coordinated care, people cycle in and out of treatment in attempts to address the root cause, facing repeated setbacks and delays in recovery.

We don’t treat heart disease with one ER visit. We don’t expect people with diabetes to manage their condition without a plan. Addiction treatment deserves the same: Recovery can’t stop at discharge.

We need to start providing care that goes beyond short-term interventions—care that is clinically grounded, condition-specific, and designed to evolve. That means proactive coordination across integrated teams and personalized treatment plans with effective step-up and step-down planning that adapts to a person’s needs over time.

Until care is continuous, integrated, and tailored, we’ll keep losing people in the gap between crisis and recovery.