Association of perceived need and barriers with subsequent treatment seeking for substance use disorders: Results from the National Epidemiologic Survey of Alcohol and Related Conditions

The majority of individuals with alcohol and illicit drug abuse and dependence in community settings do not seek substance abuse treatment. Also, they often do not report a need for such treatment. However, the impact of low perceived need and perceived barriers on treatment-seeking has not been assessed prospectively. We examined the association of these factors with subsequent substance abuse treatment-seeking in the longitudinal US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A total of 34,653 adults were interviewed in 2001-2 and again in 2004-5. In preliminary analyses, only 195 (8.5%) of the 2,335 with current substance disorders and no substance abuse treatment history had perceived an unmet need for treatment. Those with a perceived unmet need were older, more likely to have concurrent dependence and abuse symptoms, and to have comorbid mood or anxiety disorders. In multivariate analyses, participants who did perceive a need were more likely to seek treatment during the follow-up period than those who did not (14.8% vs. 4.9%, AOR= 3.05, 95% CI=1.59-5.85, p=0.001). Among those who did perceive a need, participants with pessimistic attitudes regarding substance abuse treatments (e.g., considering treatment as ineffective) were less likely than others to seek treatment (0.9% vs. 17.4%, AOR= 0.01, 95% CI=<0.01-0.21, p=0.004). Other classes of barriers and the total number of reported barriers were not associated with treatment-seeking. The findings highlight the need for educational and counseling programs to enhance recognition of substance disorders, of the need for treatment and of the benefits of such treatment.