Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices

Abstract

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.

Fig. 1

Theoretical framework of the treatment seeking process as suggested by (Saunders et al. [17]). Each step in the process of seeking treatment for an alcohol use disorder is related to specific reasons for not seeking treatment. Reprinted from Journal of Substance Abuse Treatment, 30 (3), Saunders, Zygowicz, & D'Angelo, Person-related and treatment-related barriers to alcohol treatment, p. 261–270, © 2006, with permission from ELSEVIER

Fig. 2

Flow chart for frequencies and weighted percentages of patients enclosed in the main analysis. 95 % confidence intervals (CI) are indicated in brackets. Patients diagnosed with an alcohol use disorder (AUD) by their general practitioner (GP) or by the Composite International Diagnostic Interview (CIDI) (at least 2 DSM-5 criteria fulfilled), who did not receive treatment, and reported at least one reason for not seeking treatment were included

Fig. 3

Probabilities of reporting reasons for not seeking treatment, predicted by alcohol use disorder severity. Severity of alcohol use disorders in the past 12 months ranged from sub threshold (reference) to severe as defined by DSM-5. Predictions are based on multinomial logistic regression. Reasons are grouped by Saunders' theoretical framework. 95 % confidence intervals are indicated