Even WITH drugs, if you ever talk to those kinds of people often you hear how many of them became addicts by taking their medication as prescribed. Like, as directed. Still ended up with a lovely lil opiate addiction as a result of something like even a workplace injury. Happened to me, I built my back very incorrectly from working wrong and got into painkillers. I've also seen that happen with guys I've worked with. Some people can maintain a functional life while spiraling down and it's not always that quick of a fall. Which can be like watching a trainwreck that began crashing a long ass time ago.

Then, while programs exist to get help at subsidized rates or even free of cost, they often don't seem to have great success rates for many reasons, chief among them being that the rules generally don't line up with medical science. They line up with whatever makes whoever is giving the money happy. Leads to situations where one day you go in to get your meds like you always do, but this time they say there's an issue. You see, you missed the group meeting, where everyone sits around swapping war stories about their times on drugs. Your doctor agrees that it's detrimental to your future sobriety, but you signed a contract stating you wouldn't miss group meetings. So even though you thought you'd be getting 30 days of medicine today, actually, you're getting nothing. Come back in a month to readmit into the program. If your doctor tries to intervene on your behalf, they might lose their medical license, and the clinic could have it's funding pulled.

Edit: just wanna say, that last situation I mentioned is how people die. I knew a woman who was in the same program I was in, and that exact scenario I described happened to both of us on the same day, and neither of us had ever so much as failed a piss test. I was luckily able to find another doctor and another program, but the woman wasn't as lucky, and she had overdosed by the end of the week.