A 10-year study of factors associated with alcohol treatment use and non-use in a U.S. population sample

Abstract

Background This study seeks to identify changes in perceived barriers to alcohol treatment and predictors of treatment use between 1991–92 and 2001–02, to potentially help understand reported reductions in treatment use at this time. Social, economic, and health trends during these 10 years provide a context for the study. Methods Subjects were Whites, Blacks, and Hispanics. The data were from the National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We conducted two analyses that compared the surveys on: 1) perceived treatment barriers for subjects who thought they should get help for their drinking, and 2) variables predicting past-year treatment use in an alcohol use disorder subsample using a multi-group multivariate regression model. Results In the first analysis, those barriers that reflected negative beliefs and fears about seeking treatment as well as perceptions about the lack of need for treatment were more prevalent in 2001–02. The second analysis showed that survey year moderated the relationship between public insurance coverage and treatment use. This relationship was not statistically significant in 1991–92 but was significant and positive in 2001–02, although the effect of this change on treatment use was small. Conclusions Use of alcohol treatment in the U.S. may be affected by a number of factors, such as trends in public knowledge about treatment, social pressures to reduce drinking, and changes in the public financing of treatment.

Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States

“…Consistent with the alcohol (Chartier et al, 2016; Grant, 1995; Perron et al, 2009) and cannabis (Khan et al, 2013) literatures, enabling factors most frequently endorsed among individuals with lifetime cannabis use disorder included inability to pay for services and several logistical/structural issues (e.g., time, transportation). Financial and logistical/structural barriers may be more amenable to change in the short-term (e.g., through policy interventions that increase access to insurance or transportation) than changes aimed at altering attitudes and beliefs, especially those aimed at stigma.…”

“…However, these prior studies also showed that predisposing and enabling factors (e.g., income, education) impact treatment utilization for alcohol and other drug use disorders (Chartier et al, 2016; Grella et al, 2009; Grant, 1996). An important premise of the behavioral model underlying the organizational framework of this study is the public policy concept of equitable distribution– that is, treatment services should be distributed solely on the basis of treatment need9 (Andersen, 2008; Andersen et al, 2013).…”

Characterization of Service Use for Alcohol Problems Across Generations and Sex in Adults With Alcohol Use Disorder

“…Older individuals are more likely to have endorsed utilizing services than those under the age of 45, which may reflect age‐related reporting biases and longer duration of AUD and time to recognize problems and seek treatment, or it may also reflect reduced attention to AUDs in younger cohorts (Alvanzo et al, ). Past‐year estimates of treatment utilization vary by study and range from less than 10% (Chartier et al, ) to over 20% (Evans‐Polce and Schuler, ). Of note is the fact that past‐year estimates were assessed in the 1990s (Chartier et al, ), early 2000s (Chartier et al, ), and early 2010s (Evans‐Polce and Schuler, ) which may reflect natural generational or other sample differences (see below).…”

Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender

“…However, unless directly addressed, barriers such as addiction stigma will continue to impede quality of care and utilization of services (Grant et al, 2016, 2015; Volkow, 2008). Critically, a 10-year-long epidemiological survey suggests that addiction stigma has remained stable over time in the U.S. (Chartier et al, 2016; Pescosolido et al, 2010). Simultaneously, addiction stigma continues to be understudied and poorly understood (Kulesza et al, 2013; Livingston et al, 2011).…”

“…On the individual-level, persons with SUDs might decide against seeking help to avoid anticipated stigma from healthcare providers, employers, and/or neighbors (Link et al, 2001, 1989). Longitudinal (Chartier et al, 2016) and cross-sectional data (Keyes et al, 2010; Oleski et al, 2010; Radcliffe and Stevens, 2008) indicate that individuals, who perceive high levels of addiction stigma within society, are less likely to access SUDs help and treatment services.…”