Gender Differences in Substance Abuse Treatment and Barriers to Care Among Persons With Substance Use Disorders With and Without Comorbid Major Depression

Abstract

Objectives To compare substance use disorders (SUD) treatment patterns and barriers to such treatment among men and women with SUD with and without comorbid major depressive episodes (MDE) in a community sample. Methods Using data from adult participants in the National Survey on Drug Use and Health 2005-2010, we investigated differences by gender in the association of MDE comorbidity with SUD on patterns of, perceived unmet need for, and the perceived barriers to SUD treatments. Results Compared to participants with SUD without MDE, both men and women with comorbid SUD and MDE were more likely to use SUD services or to report an unmet need for such treatment. Gender modified the association of comorbidity and treatment patterns: males with MDE comorbidity had a greater likelihood of emergency room visits and use of inpatient services than females. Barriers to substance treatment were remarkably similar for males and females in both the SUD without MDE, and with MDE groups, with attitudinal factors being the most common barriers. Conclusions Comorbidity with MDE appears to be an important predictor of service utilization and perceived need for SUD treatment in both men and women. The association of comorbidity with the use of some types of services, however, appears to vary according to gender. The findings have implications for the design of gender-specific SUD treatment programs.

Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems

“…Consistent with other research (Mojtabai & Crum, 2013; Chen et al, 2013), attitudinal barriers were cited most frequently; less often cited were structural barriers to seeking help for these problems.…”

“…These two major categories may also be further subdivided to distinguish nuances among perceived barriers to obtaining care. For example, researchers have identified financial barriers separate from other logistical barriers when assessing structural barriers (Chen, Strain, Crum, & Mojtabai, 2013; Mojtabai, Chen, Kaufmann, & Crum, 2014; Schuler, Puttaiah, Mojtabai, & Crum, 2015). Similarly, perceived stigma has been identified as distinct among other attitudinal barriers, such as pessimism about treatment (Chen et al, 2013; Schuler et al, 2015).…”

“…For example, researchers have identified financial barriers separate from other logistical barriers when assessing structural barriers (Chen, Strain, Crum, & Mojtabai, 2013; Mojtabai, Chen, Kaufmann, & Crum, 2014; Schuler, Puttaiah, Mojtabai, & Crum, 2015). Similarly, perceived stigma has been identified as distinct among other attitudinal barriers, such as pessimism about treatment (Chen et al, 2013; Schuler et al, 2015). Taken as a whole, various studies using national samples have found that individuals are more apt to cite beliefs and attitudes about treatment compared to structural barriers (e.g., cost, lack of transportation, lack of information) when asked why they did not seek help for a substance use problem (Mojtabai et al, 2011; Chen et al, 2013; Schuler et al, 2015).…”

“…Similarly, perceived stigma has been identified as distinct among other attitudinal barriers, such as pessimism about treatment (Chen et al, 2013; Schuler et al, 2015). Taken as a whole, various studies using national samples have found that individuals are more apt to cite beliefs and attitudes about treatment compared to structural barriers (e.g., cost, lack of transportation, lack of information) when asked why they did not seek help for a substance use problem (Mojtabai et al, 2011; Chen et al, 2013; Schuler et al, 2015). …”

“…Generally, severity of substance use, psychological distress, and a greater number of perceived problems related to one’s substance use increase an individual’s perception of need for help (Grella et al, 2009). A recent study found that individuals with more severe disorders were more likely to perceive a need for help and to cite structural and attitudinal/evaluative barriers (e.g., stigma, negative experience with prior treatment, perceived ineffectiveness of treatment) as compared with those with less severe disorders (Chen, Strain, Crum & Mojtabai, 2013). Another study showed that among individuals with alcohol use disorders, those with comorbid mood or anxiety disorders were more likely to seek help, but were also more likely to perceive an unmet need for treatment and to report more barriers to obtaining care (Kaufmann, Chen, Crum, & Mojtabai, 2014).…”