Perceptions of Need and Help Received for Substance Dependence in a National Probability Survey

Abstract

Objective-Most individuals with alcohol or other substance use disorders do not seek help for these problems. This study examined the factors associated with perceptions of need for help and receipt of help among individuals with alcohol or other substance dependence disorders in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Methods-The 2001-2002NESARC surveyed a representative sample of the noninstitutionalized population in the United States. Individuals with a past-year substance dependence diagnosis (N=1,602) were classified into one of three groups: received help in the past year (14.7%), perceived a need for help but did not receive it (8.5%), or perceived no need and received no help (76.8%). Multinomial logistic regression with population weights was used to examine the influence of predisposing, enabling, and need-related factors on help seeking in the past year.Results-Factors that increased the receipt of help included older age, drug dependence (versus alcohol dependence only), longer time since the onset of dependence, co-occurring mood disorder, and more problems associated with substance use. Nonwhites were about twice as likely as whites (odds ratio=2.2) to perceive a need for help but not receive it. Similarly, more problems associated with substance use increased the odds of both receiving help and perceiving a need for help but not receiving it. None of the enabling characteristics were associated with help seeking or perceived need, after analyses controlled for predisposing and need-related factors.Conclusions-Increasing the recognition of problems associated with substance dependence, particularly alcohol, may facilitate help seeking, although barriers persist in regard to age and raceethnicity.Most individuals with alcohol or drug use disorders do not seek help or receive treatment for these problems. National surveys suggest that fewer than half of those with past-year psychiatric disorders (including substance use disorders) receive any treatment (1,2). Research from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) indicated that 24% of individuals with alcohol dependence during their lifetime ever received treatment and that only 12% of individuals with past-year alcohol dependence received treatment in that year (3). Although treatment is generally higher among individuals with drug dependence, it is still far from comprehensive; current estimates suggest that 38% of those with Correspondence to: Christine E. Grella, grella@ucla.edu. The authors report no competing interests. lifetime drug dependence and 31% of those with the disorder in the past year receive treatment within those time frames (4). NIH Public AccessHealth services research has identified several factors associated with treatment. Treatment utilization is higher among individuals who have multiple types of substance use problems as well as co-occurring mental disorders (5-7). In addition to the nature and severity of disorders, the perception of need an...

Help-seeking by substance dependants presenting to healthcare professionals in the Free State Province

“…The higher ranking of OTC/analgesic dependence seen in this study is not reflected by current hard data on treatment demand, 4 evidently because these cases generally do not result in treatment. The context of help-seeking should, however, be taken into account.…”

“…2 The reluctance of alcohol-dependent persons to seek help is a universal phenomenon. 4 The study further showed that while benzodiazepine and analgesic dependence cases presented to private GPs and psychiatrists, these did not present at state hospitals ( Table 3). The frequency of help-seeking at state hospitals for heroin, cocaine and ecstasy dependence (excluding cannabis) was also low (Table 4).…”

“…5 In essence, the selection patterns reported in this study reflect the roles played by the various professional groups in dependence within a particular environment, broadly defined by socio-economic factors, medical scheme status and the availability of alternative sources of help. Considering that alcohol-dependent subjects were much less likely to seek help than other dependent types, 4 the persistent low level of help-seeking activity experienced by the group of private GPs (Table 1) demonstrates the importance of the continued involvement of this group of professional healthcare workers. The wide variation in involvement among GPs possibly reflects the influence of individual attitudes of GPs.…”

“…However, cases treated by private general practitioners, private psychiatrists and state hospitals are not reflected. 3 It is well known that the majority of substance-dependent individuals do not seek treatment for their dependence, 4 partly because of poor experiences and perceptions of treatment systems. From a service delivery viewpoint, it is therefore important to gain a clearer picture of the patient treatment interface in substance dependence.…”

Help-seeking by substance dependants presenting to healthcare professionals in the Free State Province

“…Recent studies on help-seeking investigated factors affecting help-seeking in a population of substance-dependent persons 4 and young substance-dependent adults. 5 Myers et al 7 reported on the influence of stigmatisation and negative beliefs on helpseeking in historically disadvantaged communities in South Africa.…”