“I Don’t Feel Like I Have a Problem Because I Can Still Go To Work and Function”: Problem Recognition Among Persons With Substance Use Disorders

Abstract

Background.-Persons with substance use disorders (SUD) who do not recognize their substance use as problematic are less likely to perceive needing treatment and less motivated to seek help. Factors that contribute to problem recognition among persons with SUDs are poorly understood. Objective.-To explore in-depth factors that may explain why those who meet diagnostic criteria for SUD do not perceive to have a substance abuse problem. Methods.-We recruited 54 participants with recent (i.e., past-5-year) SUD for qualitative interviews. Interviews were coded to identify prominent themes that were linked to problem recognition. Results.-We identified two prominent themes that contributed to problem recognition: modifying substance use behaviors to avoid adverse consequences and internalized stigma. Participants who reported adjusting their alcohol and drug use in ways that would not interfere with important life responsibilities, especially work-responsibilities; described those with alcohol and drug problems negatively; and associated treatment with personal defeat less likely to perceive having a substance use problem. Conclusions/Importance.-These findings can be used to inform intervention strategies aimed at increasing problem recognition among substance using populations. Such strategies may

The role of perceived treatment need in explaining racial/ethnic disparities in the use of substance abuse treatment services

“…For example, findings by Pinedo et al (2018) suggest that Latinos who are able to meet work and home responsibilities-which are aligned with strong cultural and traditional Latino values-may not perceive a need for treatment. Relatedly, studies have found that factors associated with being "high-functioning" (i.e., being able to sustain substance use without it interfering with important life aspects, such as work and career) may preclude problem recognition and discourage treatment use among persons with SUD (Nwakeze et al, 2002;Pinedo, et al, 2018;Rogers, et al, 2019). This may explain why factors in our study that may serve as proxies for being "high-functioning" (e.g., employment, education, income, insurance status) were unrelated to perceived treatment need.…”

“…A critical barrier to SUD treatment is that the majority of individuals with SUD do not perceive having a problem or needing treatment (Grella et al, 2009;Mojtabai et al, 2014;Rogers et al, 2019). The literature commonly conceptualizes perceived treatment need as a recognition by a person, who meets diagnostic clinical criteria for SUD, that their alcohol and/or drug use is problematic and that they are in need of professional help (Ali et al, 2015;Pinedo, 2020).…”

Impaired Self-Awareness and Denial During the Postacute Phases After Moderate to Severe Traumatic Brain Injury

“…While they related their findings to possible greater executive dysfunction prior to the TBI in the substance use disorder group, they did not determine whether denial within the substance use disorder prior to the TBI contributed to postinjury underreporting of deficits. It is well recognized that patients with substance use disorder often do not report their substance use to be a problem, and this appears to be a form of denial that is a major barrier to treatment (Rogers et al, 2019).…”

“I Didn't See It as a Problem, I Thought It Was Going to Be Taken Away”: Narratives From Family Members of Users in Rehab

“…Rogers et al (35) found that people with substance use problems may face difficulties in recognizing the use problem when they assume themselves as functional and adjust their consumption to stop it from obstructing their activities, mainly work-related ones. It should be noted here that the functionality notion prioritizes the labor or economic aspects over the family environment functions.…”