(48) Perceived Need for Treatment Among Adults With Severe Substance Use Disorder

Background & Introduction: Lack of perceived need for substance use (SU) treatment and difficulties with SU problem recognition are critical barriers to receiving treatment (1,2). However, characteristics associated with SU problem recognition are not well understood (1,3). This study characterizes the untreated adult population with a severe substance use disorder (SUD) who do not perceive that they need treatment.

Methods: Nationally representative data from the 2022-2023 National Surveys on Drug Use and Health were analyzed. Adults were classified as having severe SUD if they met six or more DSM-5 criteria in the past year (unweighted N=5,454). Patterns in receipt of and perceived need for SU treatment among adults with severe SUD were examined. Among adults who did not perceive a need for SU treatment, various attitudes and behaviors were examined, including whether they thought they ever had a substance use problem, received mental health (MH) treatment, perceived that they needed MH treatment, or received MH or SU support services apart from MH or SU treatment.

SU treatment included SU services received in an inpatient location, in an outpatient location, via telehealth, or in a prison, jail, or juvenile detention center, or receipt of medications for alcohol or opioid use. MH and SU support services were defined as MH- or SU- related participation in a support group, emergency department visits, receipt of detoxification/withdrawal services, or work with a peer support specialist or recovery coach. Demographic differences were examined with chi-square tests. SUDAAN procedures accounted for complex survey design. Annual averages are presented.

Results: Receipt of SU treatment was lower among adults who were younger (Ages 18-25: 23.7%, 26-34: 29.0%, 35+: 38.9%), Black (22.9% vs. White: 35.5%), or uninsured (25.1% vs. insured: 33.7%). Among adults with severe SUD in the past year, 67.4% did not receive SU treatment, of whom three-fourths 78.2% (5.2 million) did not perceive that they needed it. Among adults with severe SUD who did not receive treatment, males and young adults were more likely to perceive they did not need it (Males: 81.2% vs. Females: 73.5%; Ages 18-25: 85.7% vs. 26-34: 71.1%, 35+: 77.7%).

Among adults with severe SUD in the past year who did not perceive that they needed SU treatment, 49.1% (2.6 million) did not think that they ever had an SU problem. This percentage was higher among adults who were aged 18-25 (57.8% vs. 26-34: 46.6%, 35+: 44.4%), Black or Hispanic (Black: 67.6%, Hispanic: 58.3% vs. White: 41.7%), or whose income was below the federal poverty level [FPL] (61.6% vs. 100%-199% FPL: 48.4%, 200%+ FPL: 45.3%).

Additionally, 30.3% (1.6 million) of adults with severe SUD in the past year who did not perceive that they needed SU treatment received MH treatment in the past year, 14.3% (519,000) did not receive MH treatment but perceived that they needed it, and 5.2% (268,000) received SU or MH support services but not treatment in the past year. Receipt of MH treatment was more prevalent among adults who were aged 18-25, female, White, or insured. Receipt of MH or SU support services was more prevalent among males.

Conclusion & Discussion: Findings indicate that difficulties with SU problem recognition present a major barrier to SU recovery among millions of adults with severe SUD nationally, particularly among adults who are Black, Hispanic, or low-income. Results may point to links between racial prejudice and SU stigma (3) as well as the need for socially disadvantaged populations to maintain greater functionality so as to prevent SU from interfering with life responsibilities (1). SU interventions should understand these factors and consider ways to better reach individuals with low SU problem recognition such as avoiding Binary Disease Model language (4).

References:
1. Rogers SM, Pinedo M, Villatoro AP, Zemore SE. "I Don't Feel Like I Have a Problem Because I Can Still Go To Work and Function": Problem Recognition Among Persons With Substance Use Disorders. Subst Use Misuse. 2019;54(13):2108-2116. doi: 10.1080/10826084.2019.1630441. Epub 2019 Jun 24. PMID: 31232135; PMCID: PMC7032932.

2. Ali MM, Teich JL, Mutter R. The Role of Perceived Need and Health Insurance in Substance Use Treatment: Implications for the Affordable Care Act. JSAT. 2015;54(14-20). doi: 10.1016/j.jsat.2015.02.002. Epub 2015 Feb 13.

3. Ghonasgi R, Paschke ME, Winograd RP, Wright C, Selph E, Banks DE. The intersection of substance use stigma and anti-Black racial stigma: A scoping review. International Journal of Drug Policy. 2024;133(104612). doi: 10.1016/j.drugpo.2024.104612. Epub 2024 Oct 5.

4. Morris J, Moss AC, Albery IP, Heather N. The “alcoholic other”: Harmful drinkers resist problem recognition to manage identity threat. Addictive Behaviors. 2022;124(107093). doi: 10.1016/j.addbeh.2021.107093. Epub 2021 Aug 23.