Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders

Abstract

Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005-2011 US National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment vs. substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders.

The Role of Perceived Need and Health Insurance in Substance Use Treatment: Implications for the Affordable Care Act

“…It is possible that individuals with SUD do not seek treatment because they do not recognize that they have a disorder, or they believe that they can recover on their own, or they simply do not wish to give up their substance use. Also, concerns about being viewed negatively by one's community, adverse impact on jobs, and inconvenience of treatment were documented as reasons for not receiving treatment for substance use (Mojtabai, Chen, Kaufmann, & Crum, 2014). A possible implication of this could be that the ACA might not necessarily lead to an increase in utilization of substance abuse services even with the expansion of coverage to include SUD treatment.…”

Perceived Barriers to Treatment for Alcohol Problems: A Latent Class Analysis

“…As we review below, previous alcohol treatment studies have established associations between many of Andersen’s factors and treatment utilization, and found perceived treatment need to be one of the strongest predictors. However, many individuals who perceive a treatment need also perceive barriers to treatment; these perceived barriers are an important impediment to treatment (4,7,15-18). …”

The impact of Medicaid expansion on utilization of mental health services in west Louisville, Kentucky.

“…Research indicates that cost is the most significant barrier to health care utilization (Fang, Yang, Ayala, & Loustalot, 2014;Fayanju, Kraenzle, Drake, Oka, & Goodman, 2014;Mojtabai, Chen, Kaufmann, & Crum, 2014). Medical debt plagues more than one in five U.S. families and is associated with unmet medical need (Sommers & Cunningham, 2011).…”

“…Furthermore, the historical sensitivity, stigma, and differentiation of mental health from physical health results in the need to examine factors specifically influencing mental health service utilization. (Alegria et al, 2008;Mojtabai et al, 2014), except in terms of medication adherence, whereby individuals on public insurance are more likely to discontinue use of psychotropic medication (Hodgkin, Volpe-Vartanian, & Alegria, 2007). Of those covered by public insurance, the movement to managed care has not made a difference in use of mental health services when compared to fee-for-service programs (Bigelow, McFarland, MCCamant, Deck, & Gabriel, 2004).…”

“…Individuals may fear being hospitalized for mental illness or being forced to take medications or go to the hospital because of a cultural perception that a person should be able to handle problems on one's own (Bryant, Greer-Williams, Willis, & Hartwig, 2013;Mojtabai et al, 2014;Sareen et al, 2007). Additionally, individuals have expressed beliefs about treatment effectiveness or a mistrust of providers that impact their willingness to seek care (Alegria et al, 2008;Byers et al, 2012;Eisenberg et al, 2011).…”