Alcohol use disorder is a major cause of disease, disability, and premature mortality in the U.S.
29% of Americans will experience an alcohol use disorder at some point in their lifetime, yet only one in five of these individuals will ever receive any treatment.
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This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of 43,093 adults in the U.S. collected between 2001 and 2002. Of adults surveyed, 10,004 (23%) had a lifetime alcohol use disorder and had never received treatment. The authors used the following survey question to determine perceived need for treatment:
“Was there ever a time when you thought you should see a doctor, counselor, or other health professional or seek any other help for your drinking, but you didn’t go?”
The authors performed a latent class analysis to identify subgroups of individuals who endorsed barriers to treatment similarly. A latent class analysis is a statistical method for identifying how individuals in a study group together based on certain variables. In this study, participants were grouped based on how they endorsed barriers to treatment.
Percentage of participants who endorsed each of the perceived barriers.
The latent class analysis yielded two groups: a low-barrier class and a high-barrier class.
LOW BARRIER CLASS – A majority (87%) of participants were grouped into the low-barrier class. This class was characterized by moderate likelihood of endorsing attitudinal barriers and a lower likelihood of endorsing the items in other domains (i.e., stigma, lack of readiness to change, financial, and structural barriers). The most commonly endorsed items for this class were: “I thought I should be strong enough to handle it alone” (36%), “the problem will get better by itself” (27%), and “I stopped drinking on my own” (16%).
HIGH BARRIER CLASS – The individuals in the high-barrier class had moderate to high likelihood of endorsing the 15 items across all domains, and for each item, individuals in the high-barrier class were more likely to endorse these barriers than those in the low-barrier class. In particular, this group of participants endorsed attitudinal items, “I thought I should be strong enough to handle it alone” (77%) and “the problem will get better by itself” (77%), at a greater rate than the low-barrier class. They also had a greater propensity to endorse stigma, lack of readiness for change, financial, and structural barrier items than the low-barrier class. For example, 62% endorsed “too embarrassed to discuss it with anyone” compared to 12% in the low-barrier class.
The authors then performed an analysis to determine what factors were associated with being in the high-barrier or low-barrier class, adjusting for age, education, household income, alcohol risk and severity, and comorbid psychiatric condition.
Having an anxiety disorder and having a higher education level were significantly associated with being in the high-barrier class.
This study identified barriers to treatment for alcohol use disorder and determined two groups of people that endorse these barriers differently. The low-barrier class, which was comprised of a vast majority of participants, mainly endorsed attitudinal barriers (e.g., “should be strong enough to handle it alone”), while the high-barrier class had high endorsement of barriers in all domains, including but not limited to attitudinal barriers.
While natural recovery does occur in individuals with alcohol use disorder, particularly those with less severe problems, treatment seeking increases the odds of abstinence and recovery. Understanding these barriers to care can help address issues of treatment access experienced by people in need of treatment.
The majority of barriers to treatment for alcohol problems were attitudinal such as thinking the problem would resolve itself or that you should be strong enough to handle it alone. Given that a majority of individuals only endorsed barriers of this nature, this is a key area to explore when designing screening and treatment interventions. The authors suggest that Screening, Brief Intervention, and Referral to Treatment (SBIRT) may help identify individuals with alcohol use disorder who otherwise would not have sought treatment. Also, as authors suggest, motivational approaches delivered in primary or mental health care settings may help individuals clarify and enhance their motivation to seek treatment.
Schuler, M. S., Puttaiah, S., Mojtabai, R., & Crum, R. M. (2015). Perceived Barriers to Treatment for Alcohol Problems: A Latent Class Analysis. Psychiatr Serv, appips201400160. doi:10.1176/appi.ps.201400160
l
This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of 43,093 adults in the U.S. collected between 2001 and 2002. Of adults surveyed, 10,004 (23%) had a lifetime alcohol use disorder and had never received treatment. The authors used the following survey question to determine perceived need for treatment:
“Was there ever a time when you thought you should see a doctor, counselor, or other health professional or seek any other help for your drinking, but you didn’t go?”
The authors performed a latent class analysis to identify subgroups of individuals who endorsed barriers to treatment similarly. A latent class analysis is a statistical method for identifying how individuals in a study group together based on certain variables. In this study, participants were grouped based on how they endorsed barriers to treatment.
Percentage of participants who endorsed each of the perceived barriers.
The latent class analysis yielded two groups: a low-barrier class and a high-barrier class.
LOW BARRIER CLASS – A majority (87%) of participants were grouped into the low-barrier class. This class was characterized by moderate likelihood of endorsing attitudinal barriers and a lower likelihood of endorsing the items in other domains (i.e., stigma, lack of readiness to change, financial, and structural barriers). The most commonly endorsed items for this class were: “I thought I should be strong enough to handle it alone” (36%), “the problem will get better by itself” (27%), and “I stopped drinking on my own” (16%).
HIGH BARRIER CLASS – The individuals in the high-barrier class had moderate to high likelihood of endorsing the 15 items across all domains, and for each item, individuals in the high-barrier class were more likely to endorse these barriers than those in the low-barrier class. In particular, this group of participants endorsed attitudinal items, “I thought I should be strong enough to handle it alone” (77%) and “the problem will get better by itself” (77%), at a greater rate than the low-barrier class. They also had a greater propensity to endorse stigma, lack of readiness for change, financial, and structural barrier items than the low-barrier class. For example, 62% endorsed “too embarrassed to discuss it with anyone” compared to 12% in the low-barrier class.
The authors then performed an analysis to determine what factors were associated with being in the high-barrier or low-barrier class, adjusting for age, education, household income, alcohol risk and severity, and comorbid psychiatric condition.
Having an anxiety disorder and having a higher education level were significantly associated with being in the high-barrier class.
This study identified barriers to treatment for alcohol use disorder and determined two groups of people that endorse these barriers differently. The low-barrier class, which was comprised of a vast majority of participants, mainly endorsed attitudinal barriers (e.g., “should be strong enough to handle it alone”), while the high-barrier class had high endorsement of barriers in all domains, including but not limited to attitudinal barriers.
While natural recovery does occur in individuals with alcohol use disorder, particularly those with less severe problems, treatment seeking increases the odds of abstinence and recovery. Understanding these barriers to care can help address issues of treatment access experienced by people in need of treatment.
The majority of barriers to treatment for alcohol problems were attitudinal such as thinking the problem would resolve itself or that you should be strong enough to handle it alone. Given that a majority of individuals only endorsed barriers of this nature, this is a key area to explore when designing screening and treatment interventions. The authors suggest that Screening, Brief Intervention, and Referral to Treatment (SBIRT) may help identify individuals with alcohol use disorder who otherwise would not have sought treatment. Also, as authors suggest, motivational approaches delivered in primary or mental health care settings may help individuals clarify and enhance their motivation to seek treatment.
Schuler, M. S., Puttaiah, S., Mojtabai, R., & Crum, R. M. (2015). Perceived Barriers to Treatment for Alcohol Problems: A Latent Class Analysis. Psychiatr Serv, appips201400160. doi:10.1176/appi.ps.201400160
l
This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of 43,093 adults in the U.S. collected between 2001 and 2002. Of adults surveyed, 10,004 (23%) had a lifetime alcohol use disorder and had never received treatment. The authors used the following survey question to determine perceived need for treatment:
“Was there ever a time when you thought you should see a doctor, counselor, or other health professional or seek any other help for your drinking, but you didn’t go?”
The authors performed a latent class analysis to identify subgroups of individuals who endorsed barriers to treatment similarly. A latent class analysis is a statistical method for identifying how individuals in a study group together based on certain variables. In this study, participants were grouped based on how they endorsed barriers to treatment.
Percentage of participants who endorsed each of the perceived barriers.
The latent class analysis yielded two groups: a low-barrier class and a high-barrier class.
LOW BARRIER CLASS – A majority (87%) of participants were grouped into the low-barrier class. This class was characterized by moderate likelihood of endorsing attitudinal barriers and a lower likelihood of endorsing the items in other domains (i.e., stigma, lack of readiness to change, financial, and structural barriers). The most commonly endorsed items for this class were: “I thought I should be strong enough to handle it alone” (36%), “the problem will get better by itself” (27%), and “I stopped drinking on my own” (16%).
HIGH BARRIER CLASS – The individuals in the high-barrier class had moderate to high likelihood of endorsing the 15 items across all domains, and for each item, individuals in the high-barrier class were more likely to endorse these barriers than those in the low-barrier class. In particular, this group of participants endorsed attitudinal items, “I thought I should be strong enough to handle it alone” (77%) and “the problem will get better by itself” (77%), at a greater rate than the low-barrier class. They also had a greater propensity to endorse stigma, lack of readiness for change, financial, and structural barrier items than the low-barrier class. For example, 62% endorsed “too embarrassed to discuss it with anyone” compared to 12% in the low-barrier class.
The authors then performed an analysis to determine what factors were associated with being in the high-barrier or low-barrier class, adjusting for age, education, household income, alcohol risk and severity, and comorbid psychiatric condition.
Having an anxiety disorder and having a higher education level were significantly associated with being in the high-barrier class.
This study identified barriers to treatment for alcohol use disorder and determined two groups of people that endorse these barriers differently. The low-barrier class, which was comprised of a vast majority of participants, mainly endorsed attitudinal barriers (e.g., “should be strong enough to handle it alone”), while the high-barrier class had high endorsement of barriers in all domains, including but not limited to attitudinal barriers.
While natural recovery does occur in individuals with alcohol use disorder, particularly those with less severe problems, treatment seeking increases the odds of abstinence and recovery. Understanding these barriers to care can help address issues of treatment access experienced by people in need of treatment.
The majority of barriers to treatment for alcohol problems were attitudinal such as thinking the problem would resolve itself or that you should be strong enough to handle it alone. Given that a majority of individuals only endorsed barriers of this nature, this is a key area to explore when designing screening and treatment interventions. The authors suggest that Screening, Brief Intervention, and Referral to Treatment (SBIRT) may help identify individuals with alcohol use disorder who otherwise would not have sought treatment. Also, as authors suggest, motivational approaches delivered in primary or mental health care settings may help individuals clarify and enhance their motivation to seek treatment.
Schuler, M. S., Puttaiah, S., Mojtabai, R., & Crum, R. M. (2015). Perceived Barriers to Treatment for Alcohol Problems: A Latent Class Analysis. Psychiatr Serv, appips201400160. doi:10.1176/appi.ps.201400160
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