Weighing up the pros and cons: help-seeking by drug misusers in Baltimore, USA

Pros and cons of mental health treatment: reports from depressed clients with suicidal ideation

BACKGROUND

Suicide is a major public health problem; rates in the US have risen significantly across all age groups over the past decade. Outpatient mental health services can help to mitigate the risk of suicide. Despite highly positive effects, fewer than half of those individuals diagnosed with a mental illness receive needed mental health treatment.

AIMS

This study aims to examine the pros and cons of mental health treatment utilization and non-utilization from the perspective of depressed individual with suicidal ideation via a decisional balance worksheet.

METHODS

Depressed adults with suicidal ideation presenting to an emergency room for treatment recorded the pros and cons they associate with mental health treatment utilization and non-utilization.

RESULTS

Participants generated pros of non-utilization the least frequently (11.6%), and the pros of treatment utilization most frequently (39.6%). The most frequently cited pro of treatment utilization was "Learning New Skills", representing 40% of identified pros of utilizing treatment.

CONCLUSION

Findings suggest that reinforcing the new skills treatment can provide and ensuring every client understands treatment strategies and the reasons that treatment can be effective for their individual case may be an effective means of increasing the treatment engagement of at-risk individuals.

Relationship of reasons and fears of treatment with outcome in substance using population attending a de-addiction centre

BACKGROUND

Substance users approach a treatment facility for a variety of reasons as well as avoid or delay in help seeking due to perceived fears with treatment facilities. Sometimes these factors might be associated with treatment outcomes.

OBJECTIVES

We studied the relationship of reasons and fears of treatment seeking with treatment outcome in substance users.

MATERIALS AND METHODS

One hundred subjects, attending the Drug Deaddiction and Treatment Centre, PGIMER, were prospectively recruited by purposive sampling. A semistructured proforma was used to gather sociodemographic and clinical data. Reasons of help-seeking and fear questionnaire, social support scale, and PGI locus of control scale were then applied. Followup data were available for 69 patients, which were classified into good or poor outcome based on relapse status.

RESULTS

At 6 months followup, 22 patients had relapsed, while 47 patients did not relapse. A higher degree of dysfunction due to substance at baseline was associated with relapsed status at followup. Parents or guardians coming to know about resuming substance and being unemployed for a long time were the reasons associated with relapsed status, while needing to consult a doctor immediately was significantly related to abstinent status at followup. Fear of not being able to meet substance using friends was associated with a poorer outcome in the form of relapse.

CONCLUSIONS

Reasons for treatment seeking as well as fears related to treatment have significant implications on the clinical outcome of substance abusing patients. Addressing these could help in better patient outcomes.

Reasons for help-seeking and associated fears in subjects with substance dependence

BACKGROUND

Patients seek treatment for substance use disorders because of certain reasons that they consider significant and important, but on the other hand, they do have various fears or apprehensions about the treatment, which act as barriers for treatment-seeking. In this study, we aim to assess their reasons for seeking treatment, the associated fears about treatment, their social support and locus of control, and also to find the relationship among these variables.

MATERIALS AND METHODS

One hundred subjects attending the Drug Deaddiction and Treatment Center, Postgraduate Institute of Medical Education and Research (PGIMER) were prospectively recruited, with purposive sampling from 15 June to 14 July, 2011. The sociodemographic and clinical variables were ascertained through a semi-structured performa. The PGI Locus of Control Scale, Social Support Scale, and Reasons of Help-seeking and Fear Questionnaire were applied.

RESULTS

The common reasons for seeking treatment were - having become a habitual user, taking substance for a long time, and a need to take it every day. The common fears about treatment were the fear of disappointing others, loss of secrecy of substance use, and being considered a failure in life. The locus of control was primarily internal. Certain reasons like taking substance for a long time, feeling ill, and feeling sad were associated with a lower social support. Social support was not associated with the locus of control. The most affected areas of impairment were finance and health.

CONCLUSIONS

Certain reasons and fears regarding treatment are more common than others. It is important to look into reasons and fears that are related to better treatment outcomes.

Reasons for seeking treatment among young drug abusers in Hong Kong

This study examined the reasons for seeking treatment among 300 male young heroin abusers in Hong Kong (172 newcomers and 128 repeaters) recruited from non-government drug treatment agencies. A 55-item Reasons for Seeking Treatment Scale (Reasons Scale) was developed to measure the participants' reasons for seeking treatment. The results showed that the scale was internally consistent and six factors with reliable related subscales were extracted. The findings are generally consistent with the "hitting of the bottom" hypothesis, which posits that drug abusers will seek help only when they perceive that their addicted life is out of control. The results suggest that drug treatment and rehabilitation services should target the reasons for seeking treatment among young drug abusers.

Percepção da síndrome de dependência por pacientes em tratamento

A percepção da dependência de substâncias psicoativas é um dos principais motivadores da procura de tratamento por pessoas com este quadro clínico e a compreensão de seus significados constitui uma questão relevante em saúde. OBJETIVOS: Levantar e compreender os significados pessoais atribuídos pelos pacientes que procuraram tratamento à síndrome de dependência. MÉTODO: Pesquisa qualitativa com entrevistas semidirigidas com amostra intencional de 13 dependentes de substâncias que procuraram tratamento. RESULTADOS: Os atuais critérios para dependência de substâncias foram abordados espontaneamente pelos pacientes. Atribuíram variados significados pessoais à questão do desejo intenso, da compulsão e do descontrole quanto ao uso, e também à síndrome de abstinência, à tolerância, ao abandono de outros interesses e prazeres e à percepção das conseqüências nocivas do uso. CONCLUSÃO: Os entrevistados mostram compreensão própria do processo de procura de tratamento, avaliando meticulosa e subjetivamente o desconforto dos sintomas de dependência. Tais significados requerem especial atenção dos profissionais de saúde, sobretudo, nos atendimentos em atenção básica e, uma vez abordados, poderão facilitar a procura de tratamento.

The Use of Required Treatment for Substance Abusers

Studies show that typically less than 10% of alcohol and other drug abusers voluntarily enter treatment for their substance abuse, and once in treatment, drop out rates are high. One controversial way to get clients into, and to participate in, treatment is the use of legally encouraged or required treatment. Grounded in the parents patriae doctrine of state protection, the primary rationale for required treatment is that some substance abusers require external pressure to enter and remain in treatment. The history of required treatment for alcohol and other substance abuse, the primary issues surrounding its use, the use of required treatment in the criminal justice system, the primary treatment models for alcohol and other substance abuse, ways to increase internal and external motivation for treatment, and therapist and treatment personnel responsibilities in using required treatment are discussed.

Modeling drug dependence behaviors for animal and human studies

Laboratory models are available to study drug reinforcement in animals and humans, but few are available to study other drug dependence phenomena, e.g., difficulty stopping or use despite harm. The present paper is a first attempt to illustrate the feasibility of developing such models for use in both nonhuman and human research and discusses their possible utility in research to understand and treat stimulant and other drug dependencies.

Resolution from alcohol problems with and without treatment: reasons for change

Volunteers at a local science center were asked their reasons for quitting or reducing their alcohol consumption. Of 248 respondents, 64 were classified as having had an alcohol problem from which they had successfully resolved for 1 or more years. Three quarters of all respondents resolved without treatment or self-help groups, and over half (57.8%, 37 of 64) of these respondents' resolutions involved nonabstinence (i.e., moderate drinking). The reason for resolution most often endorsed by respondents was that they had "weighed the pros and cons of drinking and not drinking." The implications of these findings for intervention programs are discussed.

Alcohol and drug abusers' reasons for seeking treatment

Clients at two different treatment facilities were asked at assessment how influential each of 10 possible reasons were in their decision to change their alcohol or drug use. Clients at both facilities most often endorsed "weighing the pros and cons of drinking or drug use" and a "warning from spouse." Client's reasons for seeking treatment were also examined in relation to treatment compliance. Three reasons--"weighing the pros and cons," "hitting rock bottom," and experiencing a "major lifestyle change"--were predictive of treatment compliance. Clients who rated any of these reasons as influential were more likely to enter and complete treatment. Although more research is needed, knowledge of clients' reasons for seeking treatment might be useful in treatment matching.