In the past decade, the US government and other key interest groups have taken significant steps to address the addiction epidemic. Despite these efforts, 16.7% of Americans age 12+ suffer from a substance use disorder. Unfortunately, only 23% of those seek treatment with even less than 8.4% of clients completing it successfully and staying sober for more than five years (SAMHSA 2019). Consequently, this study aims to investigate the specific factors that influence treatment participation and retention. Four key domains of influence were identified and studied: confidence, hopelessness, neglect, and misalignment between clients and counselors on treatment needs. The study surveyed 60 clients and 23 counselors from established, licensed substance addiction treatment programs across the Midwest. The hopelessness of clients was determined using the Beck Hopelessness Scale. The survey identified a lack of confidence in the treatment program(s), a lack of confidence in their ability to complete the treatment program, and a lack of finances as prevailing influences in the hesitancy to seek treatment. However, after joining treatment, the effect of client hopelessness seems to have exacerbated these factors, playing a major role in treatment retention, as around 90% of non-hopeless clients see their needs being met compared to only 37% of hopeless clients (p < 0.05). This effect perpetuates the perception of neglect in clients, further isolating them from seeking or participating in treatment. Further, considerable discord has been identified between clients and counselors on the perception of those needs and challenges of clients, illuminating critical information that can improve client participation and adherence to treatment programs, significantly improving our approach to the epidemic of substance addiction.