Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys

Abstract

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality ("minimally adequate treatment"). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in uppermiddle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

“…A survey of 21 of these countries from different regions of the world on HIV-prevention and treatment-service availability reported OST coverage of <3% among PWID 21. In addition, mental health-services provision for the general population, especially in low- and middle-income countries is limited,22 and is even lower for people with substance-use disorders,23 particularly PWID. Data from the World Mental Health Survey estimate that only 1% of people with substance-use disorders in low-and middle-income countries have treatment coverage for these disorders 23.…”

“…In addition, mental health-services provision for the general population, especially in low- and middle-income countries is limited,22 and is even lower for people with substance-use disorders,23 particularly PWID. Data from the World Mental Health Survey estimate that only 1% of people with substance-use disorders in low-and middle-income countries have treatment coverage for these disorders 23. Treatment of mental illnesses among PWID has been identified as an important part of HIV prevention 24.…”

Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review

“…Substance Use Disorder (SUD) and behavioral addictions are prevalent in many countries (Degenhardt et al, 2017) and require a multidisciplinary approach. Unfortunately, only a minority (7.1%) of patients, even in high income countries, receives adequate treatment.…”

“…Unfortunately, only a minority (7.1%) of patients, even in high income countries, receives adequate treatment. Individuals diagnosed with SUD experience several relapses after interventions and a lower quality of life because of the chronic nature of these disorders (Degenhardt et al, 2017). Therefore, there is an urgent need to conduct more research to expand assessment and treatment approaches.…”

Reliability of the Addiction Severity Index self-report form (ASI-SR): a self-administered questionnaire based on the Addiction Severity Index composite score domains

“…However, compared to other Swedish ASI samples our participants reported similar severity regarding substance use, and psychiatric symptoms, although they reported less problems regarding employment, legal and family and social relationships [36][37][38]. Concerning our participation rate, it is fairly typical for what is seen in this type of population [39] and recruitment was made consecutively to enable variation in the sample. Fifty-nine participants were considered sufficient to investigate the aim of this study, generating adequate variation and distribution within the sample.…”