Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys |
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| Authors: | Louisa Degenhardt Meyer Glantz Sara Evans‐Lacko Ekaterina Sadikova Nancy Sampson Graham Thornicroft Sergio Aguilar‐Gaxiola Ali Al‐Hamzawi Jordi Alonso Laura Helena Andrade Ronny Bruffaerts Brendan Bunting Evelyn J. Bromet José Miguel Caldas de Almeida Giovanni de Girolamo Silvia Florescu Oye Gureje Josep Maria Haro Yueqin Huang Aimee Karam Elie G. Karam Andrzej Kiejna Sing Lee Jean‐Pierre Lepine Daphna Levinson Maria Elena Medina‐Mora Yosikazu Nakamura Fernando Navarro‐Mateu Beth‐Ellen Pennell José Posada‐Villa Kate Scott Dan J. Stein Margreet ten Have Yolanda Torres Zahari Zarkov Somnath Chatterji Ronald C. Kessler |
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| Affiliation: | 1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia;2. Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA;3. Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;4. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA;5. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA;6. College of Medicine, Al‐Qadisiya University, Diwaniya Governorate, Iraq;7. Health Services Research Unit, Hospital del Mar Medical Research Institute;8. Pompeu Fabra University;9. and CIBER en Epidemiología y Salud Pública, Barcelona, Spain;10. Section of Psychiatric Epidemiology, Institute of Psychiatry, University of S?o Paulo Medical School, S?o Paulo, Brazil;11. Universitair Psychiatrisch Centrum ‐ Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium;12. School of Psychology, Ulster University, Londonderry, UK;13. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA;14. Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal;15. IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy;16. National School of Public Health, Management and Professional Development, Bucharest, Romania;17. Department of Psychiatry, University College Hospital, Ibadan, Nigeria;18. Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain;19. Institute of Mental Health, Peking University, Beijing, China;20. Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon;21. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon;22. Wroclaw Medical University, University of Lower Silesia, Wroclaw, Poland;23. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong;24. H?pital Lariboisière Fernand Widal, Assistance Publique H?pitaux de Paris INSERM UMR‐S 1144, Paris Diderot and Paris Descartes Universities, Paris, France;25. Mental Health Services, Ministry of Health, Israel;26. National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico;27. Department of Public Health, Jichi Medical University, Shimotsuke, Japan;28. Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Murcia, Spain;29. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA;30. Colegio Mayor de Cundinamarca University, Bogota, Colombia;31. Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand;32. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa;33. Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands;34. Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia;35. Directorate for Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria;36. Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland |
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| Abstract: | Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross‐nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12‐month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6% met 12‐month criteria for substance use disorders; the prevalence was higher in upper‐middle income (3.3%) than in high‐income (2.6%) and low/lower‐middle income (2.0%) countries. Overall, 39.1% of those with 12‐month substance use disorders recognized a treatment need; this recognition was more common in high‐income (43.1%) than in upper‐middle (35.6%) and low/lower‐middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper‐middle, and 8.6% in low/lower‐middle income countries). Overall, only 7.1% of those with past‐year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper‐middle income and 1.0% in low/lower‐middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs. |
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| Keywords: | Substance use disorders alcohol drugs treatment coverage World Health Organization United Nations Sustainable Development Goals |
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