title: Patterns and predictors of treatment seeking after onset of a substance use disorder.
abstract: 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 [> or =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 > or =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.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
authors.forename: S
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.forename: P A
authors.initials: PA
authors.lastname: Berglund
authors.forename: J J
authors.initials: JJ
authors.lastname: Caraveo-Anduaga
authors.forename: D J
authors.initials: DJ
authors.lastname: DeWit
authors.forename: S F
authors.initials: SF
authors.lastname: Greenfield
authors.forename: B
authors.initials: B
authors.lastname: Kolody
authors.forename: M
authors.initials: M
authors.lastname: Olfson
authors.forename: W A
authors.initials: WA
authors.lastname: Vega
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires