Meredith G Harris1,2, Chrianna Bharat3, Meyer D Glantz4, Nancy A Sampson5, Ali Al-Hamzawi6, Jordi Alonso7,8, Ronny Bruffaerts9, José Miguel Caldas de Almeida10, Alfredo H Cia11, Giovanni de Girolamo12, Silvia Florescu13, Oye Gureje14, Josep Maria Haro15, Hristo Hinkov16, Elie G Karam17,18,19, Georges Karam20,21, Sing Lee22, Jean-Pierre Lépine23, Daphna Levinson24, Victor Makanjuola25, John McGrath26,27,28, Zeina Mneimneh29, Fernando Navarro-Mateu30, Marina Piazza31, José Posada-Villa32, Charlene Rapsey33, Hisateru Tachimori34, Margreet Ten Have35, Yolanda Torres36, Maria Carmen Viana37, Somnath Chatterji38, Alan M Zaslavsky5, Ronald C Kessler5, Louisa Degenhardt39. 1. School of Public Health, The University of Queensland, Herston, QLD, Australia. 2. Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD, Australia. 3. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. 4. Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Bethesda, MD, USA. 5. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 6. College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq. 7. Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. 8. CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain. 9. Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium. 10. Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. 11. Anxiety Disorders Center, Buenos Aires, Argentina. 12. IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia. 13. National School of Public Health, Management and Development, Bucharest, Romania. 14. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. 15. Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain. 16. National Center of Public Health and Analyses, Sofia, Bulgaria. 17. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon. 18. Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon. 19. Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon. 20. Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon. 21. Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon. 22. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong. 23. Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot;INSERM UMR-S 1144, Paris, France. 24. Mental Health Services, Ministry of Health, Jerusalem, Israel. 25. Department of Psychiatry, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Nigeria. 26. Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia. 27. Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia. 28. National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark. 29. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. 30. UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-, Murcia, Murcia, Spain. 31. Universidad Cayetano Heredia, Lima, Peru. 32. Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia. 33. Department of Psychological Medicine, University of Otago, Dunedin School of Medicine, Otago, New Zealand. 34. National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan. 35. Trimbos-Instituut, the Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands. 36. Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia. 37. Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil. 38. Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland. 39. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Abstract
AIMS: To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN: Cross-sectional, representative household surveys. SETTING: Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS: A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS: Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS: Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS: Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.
AIMS: To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN: Cross-sectional, representative household surveys. SETTING: Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS: A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS: Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS: Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS: Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.
Authors: Kimberly A Hepner; Susan M Paddock; Katherine E Watkins; Songthip T Ounpraseuth; Amy M Schrader; Teresa J Hudson Journal: Psychiatr Serv Date: 2017-07-03 Impact factor: 3.084
Authors: Marlous Tuithof; Margreet Ten Have; Wim van den Brink; Wilma Vollebergh; Ron de Graaf Journal: Eur Addict Res Date: 2016-06-09 Impact factor: 3.015