Key takeaway
You have put off asking for help because you expect judgment, or you have stopped trying because you believe you are not valued. That belief keeps people out of care. People with a substance use disorder stick with treatment as often as people treated for hypertension or diabetes. Tonight, tell one safe person or ask for a program.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
You have put off asking for help because you expect to be judged. Or you stopped trying, because you believe you are not valued anyway. The research calls that second trap the why-try effect. Why try to live and work on your own if the people around you have already decided you do not count?
If that judgment has turned into a plan to harm yourself, call or text 988. If you are in immediate danger, call 911.
You can ask before the judgment lifts
A National Academies committee, writing for SAMHSA, describes stigma as attitudes, beliefs, behaviors, and structures that become prejudice and discrimination. Laws, employers, schools, clinics, and the justice system can carry it. So can strangers, including first responders and clergy. Self-stigma is what happens when you apply that story to yourself. It lowers self-esteem and the belief that you can take the next step, and it comes with embarrassment and shame.
People with substance use disorders are often treated as more to blame than people with depression or schizophrenia, and as weak-willed. The evidence the committee cites says they stick with treatment as much as people treated for hypertension or diabetes.
Low self-worth plus that public story is how the why-try effect takes hold. It is tied to less help-seeking, and to not pursuing work or an independent life. Policies that have treated substance use mainly as a crime have pushed people out of ordinary life. You do not have to win that argument tonight.
Tell one person who has not used this against you, or call and ask for a program. If you choose a coworker, read telling coworkers before you speak at work.
Call or text (800) 653-9376 if you want help finding a program tonight.
Additional Resources
Sources cited on this page:
- National Academies: Ending Discrimination Against People with Mental and Substance Use Disorders, chapter 2 (NBK384923)
- National Academies: Ending Discrimination Against People with Mental and Substance Use Disorders (full report, including the SAMHSA task statement)
- 988 Suicide & Crisis Lifeline
- SAMHSA FindTreatment.gov
- SmarterRecovery about page (referral disclosure)
Common Questions
Why do people skip care even when they know where it is?
A 2014 SAMHSA survey, cited by the committee, asked about behavioral health care as a whole, not substance use alone. Among the reasons for going without care: concern about confidentiality, 10 percent; worry that neighbors or the community would think badly of them, 10 percent; and worry about a negative effect on a job, 8 percent. Cost, thinking they could handle it without treatment, and not knowing where to go were larger shares in that same list.
What happened when addiction was described as a brain disease?
The committee reports a lack of solid evidence that a neurobiological story reduces stigma. Spreading the brain-disease model has not clearly reduced public stigma, and that framing may lower how capable people are thought to be. You can ask for care whether or not the people around you have heard a medical explanation.
Do people assume I am dangerous?
The committee says people with substance use disorders are often seen as more dangerous than people with schizophrenia or depression. In one U.S. survey, a vast majority thought it likely that a person dependent on cocaine or alcohol would hurt others. People were less likely to endorse that violence stereotype after direct contact that did not harm them. Planned contact, in the bulk of the evidence the committee reviews, lines up with lower stigma. A few studies find the opposite.
Do I have to tell people at work?
No. People who have disclosed report lower self-stigma, and disclosure can be an early step when it is safe and deliberate. You choose the person. If that person is a coworker, use [telling coworkers](/guides/telling-coworkers-about-recovery/) only when you want that conversation. Fear of stigma has kept help out of reach more often for racial and ethnic minorities, youth, men, military members, and health professionals.
What if a clinician treats this as hopeless?
Negative attitudes among clinicians are common, including outside behavioral health. Population studies show high remission rates for alcohol dependence, and many professionals still treat alcoholism as incurable. You can ask for a different clinician.