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Ronald C. Kessler, PhD; Sergio Aguilar-Gaxiola, MD, PhD; Patricia A. Berglund, MBA; Jorge J. Caraveo-Anduaga, MD, MPH; David J. DeWit, PhD; Shelly F. Greenfield, MD, MPH; Bohdan Kolody, PhD; Mark Olfson, MD, MPH; William A. Vega, PhD

Arch Gen Psychiatry. 2001;58:1065-1071.

Background  We studied survey respondents aged 18 through 54 years to determine consistent predictors of treatment seeking after onset of a DSM-III-R substance use disorder.

Methods  Survey populations included a regional sample in Ontario (n = 6261), a national sample in the United States (n = 5388), and local samples in Fresno, Calif (n = 2874) and Mexico City, Mexico (n = 1734). The analysis examined the effects of demographics, symptoms, and types of substances on treatment seeking.

Results  Between 50% (Ontario) and 85% (Fresno) of people with substance use disorders seek treatment but the time lag between onset and treatment seeking averages a decade or more. Consistent predictors of treatment seeking include: (1) late onset of disorder (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.6-5.6 for late [30 years] vs early [1-15 years] age at first symptom of disorder); (2) recency of cohort (OR, 3.4; 95% CI, 2.3-5.0 for most recent [aged 15-24 years at interview] vs earliest [aged 45 years] cohorts); (3) 4 specific dependence symptoms (using larger amounts than intended, unsuccessful attempts to cut down use, tolerance, and withdrawal symptoms), with ORs ranging between 1.6 (95% CI, 1.3-2.0) and 2.7 (95% CI, 2.1-3.6) for people with vs without these symptoms; and (4) use vs nonuse of cocaine (OR, 2.1; 95% CI, 1.6-2.7) and heroin (OR, 2.6; 95% CI, 1.1-6.0).

Conclusions  Although most people with substance use disorders eventually seek treatment, treatment seeking often occurs a decade or more after the onset of symptoms of disorder. While treatment seeking has increased in recent years, it is not clear whether this is because of increased access, increased demand, increased societal pressures, or other factors.

From the Departments of Health Care Policy (Dr Kessler), and Psychiatry (Dr Greenfield), Harvard Medical School, Boston, Mass; the Department of Psychology, School of Natural Sciences, California State University, Fresno (Dr Aguilar-Gaxiola); the Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); Instituto Mexicano de Psiquiatria, Huipulco, Mexico (Caraveo-Anduaga); the Addiction Research Foundation, Clinical, Social, and Evaluation Research Department, London, Ontario (Dr DeWit); McLean Hospital, Belmont, Mass (Dr Greenfield); Sociology Department, San Diego State University, San Diego, Calif (Dr Kolody); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (Dr Olfson); and Robert Wood Johnson Medical School–UMDNJ, Institute for Quality Research and Training, New Brunswick, NJ (Dr Vega).

Corresponding author and reprints: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (e-mail: kessler{at}hcp.med.harvard.edu).

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