TY - JOUR
T1 - Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys
AU - Harris, Meredith G.
AU - Bharat, Chrianna
AU - Glantz, Meyer D.
AU - Sampson, Nancy A.
AU - Al-Hamzawi, Ali
AU - Alonso, Jordi
AU - Bruffaerts, Ronny
AU - Caldas de Almeida, José Miguel
AU - Cia, Alfredo H.
AU - de Girolamo, Giovanni
AU - Florescu, Silvia
AU - Gureje, Oye
AU - Haro, Josep Maria
AU - Hinkov, Hristo
AU - Karam, Elie G.
AU - Karam, Georges
AU - Lee, Sing
AU - Lépine, Jean Pierre
AU - Levinson, Daphna
AU - Makanjuola, Victor
AU - McGrath, John
AU - Mneimneh, Zeina
AU - Navarro-Mateu, Fernando
AU - Piazza, Marina
AU - Posada-Villa, José
AU - Rapsey, Charlene
AU - Tachimori, Hisateru
AU - ten Have, Margreet
AU - Torres, Yolanda
AU - Viana, Maria Carmen
AU - Chatterji, Somnath
AU - Zaslavsky, Alan M.
AU - Kessler, Ronald C.
AU - Degenhardt, Louisa
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Comorbidity
KW - mental disorders
KW - minimally adequate treatment
KW - substance use disorders
KW - treatment
KW - World Mental Health Surveys
UR - http://www.scopus.com/inward/record.url?scp=85066930209&partnerID=8YFLogxK
U2 - 10.1111/add.14599
DO - 10.1111/add.14599
M3 - Article
C2 - 30835879
AN - SCOPUS:85066930209
SN - 0965-2140
JO - Addiction
JF - Addiction
ER -