Background We studied survey respondents aged 18 through 54 years to determine consistent predictors of treatment seeking after onset of a DSM-III-R substance use disorder. Methods Survey populations included a regional sample in Ontario (n = 6261), a national sample in the United States (n = 5388), and local samples in Fresno, Calif (n = 2874) and Mexico City, Mexico (n = 1734). The analysis examined the effects of demographics, symptoms, and types of substances on treatment seeking. Results Between 50% (Ontario) and 85% (Fresno) of people with substance use disorders seek treatment but the time lag between onset and treatment seeking averages a decade or more. Consistent predictors of treatment seeking include: (1) late onset of disorder (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.6-5.6 for late [≥30 years] vs early [1-15 years] age at first symptom of disorder); (2) recency of cohort (OR, 3.4; 95% CI, 2.3-5.0 for most recent [aged 15-24 years at interview] vs earliest [aged ≥45 years] cohorts); (3) 4 specific dependence symptoms (using larger amounts than intended, unsuccessful attempts to cut down use, tolerance, and withdrawal symptoms), with ORs ranging between 1.6 (95% CI, 1.3-2.0) and 2.7 (95% CI, 2.1-3.6) for people with vs without these symptoms; and (4) use vs nonuse of cocaine (OR, 2.1; 95% CI, 1.6-2.7) and heroin (OR, 2.6; 95% CI, 1.1-6.0). Conclusions Although most people with substance use disorders eventually seek treatment, treatment seeking often occurs a decade or more after the onset of symptoms of disorder. While treatment seeking has increased in recent years, it is not clear whether this is because of increased access, increased demand, increased societal pressures, or other factors.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/481850/yoa20183.pdf

Patterns and predictors of treatment seeking after onset of a substance use disorder

Aims This clinical trial investigated effects of motivational enhancement treatment (MET) and group coping-skills training (CST) tailored for cocaine dependence. Effects of MET were hypothesized to be greater with CST and for less motivated patients.

Design and interventions  A 2 × 2 design investigated two individual sessions of MET compared to meditation–relaxation (MRT), followed by four group sessions of CST versus drug education (ED), as daily adjuncts to intensive treatment.

Setting  The substance abuse program provided full-day treatment with a learning-theory and 12-Step orientation.

Participants  Cocaine-dependent patients were recruited.

Measurements  Assessment included treatment retention; change in cocaine-related urge, self-efficacy, pros and cons, and motivation; substance use and problems during 12-month follow-up.

Findings  Of 165 patients, follow-up status is known for 90% (n = 149). Patients in MET with low initial motivation to change reported less cocaine and alcohol relapse and use days and fewer alcohol problems than MET patients with higher initial motivation. MET produced more employment improvement than MRT, with no other significant benefit for MET. Patients with higher motivation had more cocaine use and alcohol problems after MET than MRT. Group CST reduced cocaine and alcohol use during follow-up for women only and reduced alcohol relapse for men and women.

Conclusions  MET is more beneficial for patients with lower initial motivation than for patients with high initial motivation. CST reduced cocaine and alcohol use for women only and reduced alcohol relapses, in contrast to results with lengthier individual CST.

Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes

College students rarely seek help despite serious substance use problems

Factors that predict adolescent motivation for substance abuse treatment

Aims. Coping skills training, a promising treatment approach for alcoholics, was adapted for use with cocaine abusers and effects on outcome were investigated. Design. A cocaine-specific coping skills training (CST) package was compared to an attention placebo control when both were added to a comprehensive treatment program. Setting. The sites were two private substance abuse treatment facilities, one residential and rural, and one an urban partial hospital. Participants. Substance abusers in treatment with cocaine abuse or dependence were selected. Intervention. The CST intervention was conducted in individual sessions. It involved functional analysis of high risk situations and coping skills training based on the functional analysis. Findings. Clients who received CST had significantly fewer cocaine use days and the length of their longest binge was significantly shorter during the 3-month follow-up period compared to clients in the control condition. CST did not affect relapse rates or use of other substances. Conclusions. Results support the notion that cocaine-specific CST is a promising adjunct to treatment for cocaine abusers.

Brief coping skills treatment for cocaine abuse : substance use outcomes at three months

Motivational and decisional models suggest that those who seek help for substance use problems may differ from those who do not seek help in terms of their belief that substance use is creating social and personal negative consequences and their perceived dependence. In this study, help seeking for cocaine use was hypothesized to be a function of the negative consequences from cocaine, perceiving oneself as dependent on cocaine, quantity and frequency of use, cost of use, and route of administration. A sample of 161 substance abusers in treatment who had used any cocaine in the last 6 months completed questionnaires regarding the quantity, frequency, history, and perceptions of the consequences of their cocaine use. Of the 161 subjects, 113 (70.2%) had at some time sought help from someone for their cocaine use. After controlling for marital and employment status, a logistic regression revealed that the number of negative consequences experienced, feeling dependent on cocaine, and the amount of cocaine us...

Selene M. Varney

Papers

Factors Associated with Help Seeking and Perceived Dependence among Cocaine Users

A cocaine high-risk situations questionnaire: Development and psychometric properties

A cocaine negative consequences checklist: development and validation