title: Facilitators and barriers in treatment seeking for cannabis dependence.
abstract: BACKGROUND
  Relatively few cannabis dependent people seek treatment and little is known about determinants of treatment seeking.
  
  
  METHODS
  Treatment determinants were compared among 70 DSM-IV cannabis dependent patients and 241 non-treatment seeking DSM-IV cannabis dependent community subjects. In addition, perceived facilitators for treatment seeking were assessed in patients, whereas perceived barriers were assessed in 160/241 cannabis dependent community subjects not prepared to seek treatment (precluders), of whom 63/160 showed an objective treatment need, and 30/241 showed a subjective treatment need.
  
  
  RESULTS
  Compared to non-treatment seekers, patients reported more cannabis use (176.9 versus 82.8 joints monthly), more symptoms of dependence (5.6 versus 4.5), higher perceived lack of social support (70.0% versus 41.1%), more pressure to seek treatment (58.6% versus 21.6%), a more positive attitude to treatment, and more previous treatments. In addition, patients reported more mental health problems (internalising disorders 57.1% versus 24.5%; externalising disorders 52.9% versus 35.3%) and more functional impairments (8.4 versus 4.8 monthly days out of role). Cannabis dependent 'precluders' reported desire for self-reliance (50.0%), preference for informal help (22.5%), and absent treatment need (16.9%) as their main reasons not to seek treatment, whereas cannabis dependent community subjects with a subjective treatment need mainly expressed desire for self-reliance (36.7%), treatment ineffectiveness (16.7%), and avoiding stigma (13.3%).
  
  
  CONCLUSIONS
  Functional impairment, mental health problems and social pressure are important reasons to seek treatment in people with cannabis dependence. Treatment participation might improve if desire for self-reliance and the preference for informal help are considered, and perceived ineffectiveness of treatment and stigmatisation are publicly addressed.
authors.affiliation: Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands. Electronic address: ppol@trimbos.nl.
authors.forename: Peggy
authors.initials: P
authors.lastname: van der Pol
authors.forename: Nienke
authors.initials: N
authors.lastname: Liebregts
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Korf
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.forename: Margriet
authors.initials: M
authors.lastname: van Laar
mesh_terms: D000293:Adolescent; D000328:Adult; D001290:Attitude; D015331:Cohort Studies; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000628:therapy*; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008605:Mental Health Services; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057545:Social Stigma; D012959:Socioeconomic Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: Cannabis dependence; Comorbid disorders; Functional impairment; Treatment