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Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys

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Louisa Degenhardt, Meyer Glantz, Sara Evans-Lacko, Ekaterina Sadikova, Nancy Sampson, Graham Thornicroft, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Ronny Bruffaerts, Brendan Bunting, Evelyn J. Bromet, José Miguel Caldas de Almeida, Giovanni de Girolamo, Silvia Florescu, Oye Gureje, Josep Maria Haro, Yueqin Huang, Aimee Karam & 105 more Elie G. Karam, Andrzej Kiejna, Sing Lee, Jean Pierre Lepine, Daphna Levinson, Maria Elena Medina-Mora, Yosikazu Nakamura, Fernando Navarro-Mateu, Beth Ellen Pennell, José Posada-Villa, Kate Scott, Dan J. Stein, Margreet ten Have, Yolanda Torres, Zahari Zarkov, Somnath Chatterji, Ronald C. Kessler, Tomasz Adamowski, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Mohammad Al-Kaisy, Jordi Alonso, Yasmin Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Randy P. Auerbach, William G. Axinn, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas de Almeida, Graça Cardoso, Stephanie Chardoul, Somnath Chatterji, Alexandre Chiavegatto Filho, Alfredo H. Cia, Pim Cuijpers, Louisa Degenhardt, Giovanni de Girolamo, Ron de Graaf, Peter de Jonge, David D. Ebert, Sara Evans-Lacko, John Fayyad, Silvia Florescu, Sandro Galea, Laura Germine, Dirgha J. Ghimire, Stephen E. Gilman, Meyer D. Glantz, Semyon Gluzman, Oye Gureje, Josep Maria Haro, Meredith G. Harris, Yanling He, Hristo Hinkov, Chi Yi Hu, Yueqin Huang, Aimee Nasser Karam, Elie G. Karam, Norito Kawakami, Ronald C. Kessler, Andrzej Kiejna, Karestan C. Koenen, Viviane Kovess-Masfety, Carmen Lara, Sing Lee, Jean Pierre Lepine, Itzhak Levav, Daphna Levinson, Zhaorui Liu, Silvia S. Martins, John J. McGrath, Katie A. McLaughlin, Maria Elena Medina-Mora, Zeina Mneimneh, Jacek Moskalewicz, Fernando Navarro-Mateu, Matthew K. Nock, Siobhan O'Neill, Johan Ormel, Beth Ellen Pennell, Marina Piazza, Patryk Piotrowski, José Posada-Villa, Ayelet M. Ruscio, Kate M. Scott, Tim Slade, Jordan W. Smoller, Juan Carlos Stagnaro, Dan J. Stein, Amy E. Street, Hisateru Tachimori, Margreet ten Have, Graham Thornicroft, Yolanda Torres, Gemma Vilagut, Maria Carmen Viana, Elisabeth Wells, David R. Williams, Michelle A. Williams, Bogdan Wojtyniak, Alan M. Zaslavsky

Original languageEnglish
Pages (from-to)299-307
Number of pages9
JournalWorld Psychiatry
Volume16
Issue number3
DOIs
Publication statusPublished - 21 Sep 2017

King's Authors

Abstract

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.

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