Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices.
BACKGROUND
Alcohol use disorders are among the mental disorders with the lowest treatment rates. Increasing the treatment rates requires insight on the reasons why patients do not seek treatment. This study examined self-reported reasons for not seeking treatment and their association with alcohol use disorder severity among primary health care patients diagnosed with an alcohol use disorder.


METHODS
Alcohol use disorders, health service utilization, and reasons for not seeking treatment were assessed via interviews on regionally representative samples of primary care patients from 6 European countries (Italy, Germany, Hungary, Latvia, Poland and Spain, total N = 9,098). Additionally, general practitioners had to fill in a questionnaire assessing their patients' alcohol use and alcohol use disorders. A multinomial logistic regression was performed to investigate the association between reasons for not seeking treatment and alcohol use disorder severity.


RESULTS
Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority (N = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was 'lack of problem awareness' (55.3% of those who responded), the second most common response was 'stigma or shame' (28.6%), followed by 'encounter barriers' (22.8%) and 'cope alone' (20.9%). The results indicated lower probabilities of reporting 'denial' and higher probabilities to report 'encounter barriers' as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders.


CONCLUSIONS
Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage.
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. charlotte.probst@tu-dresden.de.|Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. charlotte.probst@tu-dresden.de.
Charlotte
C
Probst
Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jakobmanthey@snappyquest.org.
Jakob
J
Manthey
Department of Addiction, Hospital Clínic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain. amartigim@gmail.com.
Alicia
A
Martinez
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.|Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jtrehm@gmail.com.|Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. jtrehm@gmail.com.|Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, ON M5S 1A8, Canada. jtrehm@gmail.com.|Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.
Jürgen
J
Rehm
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D001364:Awareness; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D057545:Social Stigma; D055815:Young Adult