Who me?

Discouraging news in terms of attraction to treatment:

A lack of perceived need for treatment is still a key reason for the low rate of treatment in people with alcohol-use disorder and for the lack of progress in reducing the scale of this problem, according to an analysis of recent large surveys in the United States.

In the National Survey on Drug Use and Health (NSDUH) dataset, 7,009 respondents met the diagnostic criteria for an alcohol-use disorder (dependence or abuse), among whom 89.6 percent said they did not perceive a need for treatment or counseling for their alcohol use in the prior 12 months. In the 3,305 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who met the criteria for alcohol-use disorder, a similar rate of 89 percent said they did not think they needed treatment for alcohol-use treatment.

This is an important challenge for providers. How do we attract people who are not coerced and/or late stage? It’s time for providers to take responsibility for this.

It would be more meaningful if they separated dependence and abuse.

2 thoughts on “Who me?

  1. Jason,Regarding your December 18th posting “ Who me? Discouraging news in terms of attraction to treatment”. The news is not as discouraging as the Edlund et al 2009 article implies.Yes, many individuals with alcohol use disorders do not perceive a need for treatment. This is because many of the individuals with only mild or moderate alcohol dependence do not need treatment.The epidemiologic diagnosis of alcohol dependence is not a measure of "alcoholics" who need treatment.The problem in using epidemiologic studies to determine need for treatment is that all individuals with the epidemiologic diagnosis “alcohol dependence” are lumped together without differentiation by severity and include a majority of individuals who would not be perceived by a clinician or by themselves as needing treatmentIndividuals with an epidemiologic diagnosis of mild (3-9 symptoms) alcohol dependence do not have the same need for treatment as those with severe (20-33 symptoms) alcohol dependence.The NESARC data indicated that 30% of the DSM-IV alcohol dependent individuals are mild alcohol dependent and 19% are severe alcohol dependent, ses Dawson et al 2005, Table 1.An example of the NESARC diagnosis of DSM-IV alcohol dependence would be an individual who in recalling a single episode of heavy drinking and partying responds “Yes” to the following three alcohol symptom questions and “No” to the other 30 alcohol symptom questions:· "Ever find usual number of drinks had less effect than before" · "Ever have a period when spent a lot of time drinking" · "Ever have period when ended up drinking more than intended " These three “Yes” responses are sufficient to meet the NESARC diagnosis of DSM-IV alcohol dependence, that is “one or more symptoms of at least three of the seven alcohol dependence criteria”. Only “mild” alcohol dependence, but still a DSM-IV diagnosis of alcohol dependence. A more accurate estimate of treatment need would be the percentage of severe alcohol dependent individuals who perceive a need for treatment.Regards,Loran– LORAN ARCHERSilver Spring, MD USAloranarcher@gmail.comwww.alcoholreports.blogspot.comTel: 301-572-1519 Silver Spring MD

  2. Thank you Loran. That answers my comment about it being more helpful if they broke out dependence and abuse. Was there any more data on self-perceived need for treatment among those with more severe problems.I still think that the treatment system's reliance on coercion and the failure to attract clients in earlier stages of SUDs.Thanks for the info!

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