Person-related and Treatment-related Barriers to Alcohol Treatment

Treatment underutilization by persons with alcohol use disorder is well-documented. This study examined barriers to treatment at the latter stages of the treatment-seeking process, which was conceptualized as recognizing the problem, deciding that change is necessary, deciding that professional help is required, and seeking care. All participants identified themselves as having a drinking problem that was severe enough to warrant treatment. Differences between those who had (Treatment Seekers) and those who had not (Comparison Controls) sought treatment were evaluated, including the experience of person-related (e.g., shame) and treatment-related (e.g., cost) barriers. Person-related barriers were more commonly endorsed by both groups than treatment-related barriers. Comparison Controls were more likely to endorse both types of barriers, especially the preference for handling the problem without treatment. Treatment-related barriers were less relevant than person-related barriers at the latter stage of help seeking. The significance of barriers endured after accounting for other differences, such as drinking-related negative consequences. Treatment implications are discussed

An evaluation of a harm reduction based outpatient substance abuse treatment program for chronic recidivists

Research in addictions treatment has shown that traditional approaches to serving persons with substance misuse disorders are ineffective in two of three people who receive treatment. This poor efficacy is associated with high rates of recidivism in some populations. Harm reduction has been proposed as an alternative or additional approach to treating addictions that emphasizes low threshold access to clinical services. This is in opposition to the predominant treatment models, which are based on the Medical/Disease and Moral models of substance misuse. The purpose of the current study is to evaluate an outpatient substance abuse treatment program, the Treatment Alternative Group (TAG), based on a harm reduction model. This evaluation was approached from a cost-efficacy and service utilization perspective. Data was collected from two groups of veterans, including TAG members (Experimental Group) and a comparison group of veterans who would have been eligible for the program had it been available in the past. Preliminary analyses indicated that the groups were well matched on demographic and clinical profiles, although there were relatively fewer African-American participants in the Experimental Group. Groups were compared on costs associated with inpatient and outpatient mental health care and outpatient medical care in the time periods immediately before and after joining the TAG (Experimental Group) or becoming eligible for the group (Comparison Group). Admission rates and average length of stay per admission were also compared. Results indicated that Experimental Group participants demonstrated a significant decrease in costs of inpatient mental health and outpatient medical care. The number of inpatient psychiatric admissions and average length of stay per admission were also significantly reduced following admission to the TAG. Similar reductions were not observed in the Comparison Group. Although the Experimental Group incurred significantly higher inpatient psychiatric costs in the pre-TAG period, the groups were not different in the post-TAG period. While the current study had several limitations, these results are interpreted as strong preliminary evidence for the efficacy of the TAG, notably the harm reduction aspects of the program. Limitations of the current study and suggestions for future research in this area are also discussed