title: Perceived Barriers to Treatment for Alcohol Problems: A Latent Class Analysis.
abstract: OBJECTIVE
  Low rates of alcohol treatment seeking have been shown to be associated with perceived barriers to treatment, but heterogeneity in patterns of perceived barriers has not been explored. The study analyzed data from a population-based sample of adults with alcohol abuse and dependence in order to describe latent classes of individuals who reported one or more of 15 perceived barriers to seeking alcohol treatment and to identify characteristics associated with class membership.
  
  
  METHODS
  Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002). Analyses were restricted to treatment-naive adults with alcohol abuse or dependence who reported a perceived treatment need (N=1,053). Latent class analysis was performed to identify subgroups with respect to barriers to treatment. Latent class regression identified variables associated with each subgroup.
  
  
  RESULTS
  Two subgroups emerged: the low-barriers class (87%), characterized primarily by attitudinal barriers, and the high-barriers class (13%), characterized by significant attitudinal, financial, stigma, and readiness-for-change barriers. In both classes, the most frequently endorsed barrier was the attitudinal belief that "I should be strong enough" to handle the problem without treatment. Univariate analyses showed strong associations between membership in the high-barriers class and comorbid psychiatric disorders, alcohol dependence (compared with abuse), and a family history of alcohol problems. Multivariate analyses found significant associations with a lifetime anxiety disorder and with education level.
  
  
  CONCLUSIONS
  Attitudinal barriers were most prevalent. Findings revealed a notable subgroup with multiple barriers, including financial and stigma-related barriers. This subgroup may require additional resources and support to enter treatment.
authors.affiliation: Dr. Schuler is with the Methodology Center, Pennsylvania State University, State College (e-mail: msschuler@gmail.com ). Dr. Puttaiah is with the Department of Psychiatry, Sinai Hospital, Baltimore. Dr. Mojtabai is with the Department of Mental Health and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Schuler
authors.affiliation: Dr. Schuler is with the Methodology Center, Pennsylvania State University, State College (e-mail: msschuler@gmail.com ). Dr. Puttaiah is with the Department of Psychiatry, Sinai Hospital, Baltimore. Dr. Mojtabai is with the Department of Mental Health and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore.
authors.forename: Savitha
authors.initials: S
authors.lastname: Puttaiah
authors.affiliation: Dr. Schuler is with the Methodology Center, Pennsylvania State University, State College (e-mail: msschuler@gmail.com ). Dr. Puttaiah is with the Department of Psychiatry, Sinai Hospital, Baltimore. Dr. Mojtabai is with the Department of Mental Health and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore.
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
authors.affiliation: Dr. Schuler is with the Methodology Center, Pennsylvania State University, State College (e-mail: msschuler@gmail.com ). Dr. Puttaiah is with the Department of Psychiatry, Sinai Hospital, Baltimore. Dr. Mojtabai is with the Department of Mental Health and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D012044:Regression Analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult