Motivation for change and barriers to treatment among young cannabis users

Exploring indicators of natural recovery from alcohol and drug use problems: findings from the life in recovery survey in Flanders

INTRODUCTION

Research has established natural recovery (NR) as an important pathway to substance use recovery. Studies investigating correlates of NR have mainly focused on demographic and substance use variables rather than life circumstances. This study seeks to better understand the phenomenon of natural recovery by (i) validating the international scientific literature concerning demographic and substance use indicators of NR in Flanders and (ii) assessing the additional explanatory power of recovery strengths and barriers during active addiction, controlling for demographic and substance use covariates.

METHODS

A total of 343 persons in recovery from alcohol or drug use problems (≥ 3 months) completed an online cross-sectional survey in Flanders. Participants in NR and in recovery after following treatment were compared using multivariate linear regression models. Reasons for not following treatment were analyzed using inductive thematic analysis.

RESULTS

Higher education level, lower severity of dependence, and cannabis use as the main problem substance (vs. alcohol) were statistically significant (p < 0.05) correlates of NR. When scores for the number of barriers and strengths associated with active addiction were added, barriers (but not strengths) were significantly associated with NR. When barrier items were individually tested, having untreated emotional or mental health problems, having a driver's license revoked and damaging property were statistically significant correlates. The most reported reason for not entering treatment was not experiencing any need to do so.

CONCLUSION

The results highlight the importance of a holistic approach to recovery support across multiple life domains. Limitations and opportunities for further research are discussed.

Self-change from problems with alcohol and drugs: A scoping review of the literature since 2010

ISSUES

Self-change from alcohol and drug use problems is increasingly acknowledged in research. Despite the growing number of published studies, the most recent broad review of this dispersed field dates back to 2010. The present review narratively synthesises key findings from empirical studies and critically identifies research gaps and directions for further research.

APPROACH

Following the PRISMA guidelines for scoping reviews, a systematic search was conducted in multiple scientific databases, resulting in the identification of 56 relevant articles with explicit empirical results on self-change.

KEY FINDINGS

The scoping review presents findings related to: (i) methods and definitions used; (ii) the prevalence of self-change; (iii) indicators of self-change; (iv) the process of self-change; and (v) population views on self-change.

CONCLUSION

The review highlights the significant growth in research on self-change considering key themes as well as the need for a relational and time-bound approach to self-change in research and practice.

Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review

BACKGROUND

The advancement of universal health coverage (UHC) is largely based on identifying and addressing barriers to accessing community health services. Traditional qualitative research approaches provide excellent insights but have unfeasibly high resource requirements for most care providers.

AIM

To identify, categorise, and evaluate methods that have been used to identify barriers to and/or solutions for improving access to community-based health services, grounded in engagement with affected communities, excluding approaches that take >14 days.

DESIGN & SETTING

This was a scoping review.

METHOD

Following Joanna Briggs Institute (JBI) guidelines, a search was undertaken using the Cochrane Library, Ovid MEDLINE, Ovid Embase, Ovid Global Health, and Google Scholar. An information specialist designed the search, and dual independent review and data charting were used.

RESULTS

In total, 44 studies were included from 30 countries, reporting on 18 different clinical services. Thirty studies used self-described 'rapid' approaches; however, the majority of these did not justify what they meant by this term. Nearly half of the studies used mixed- or multi-methods and triangulation to verify early findings. All of the qualitative studies used interviews and/or focus groups, which were often supplemented with observations, document review, and mapping activities. The use of in situ snowball and convenience sampling; community members as data collectors and cultural guides; collaborative summarisation (review of findings with community members and end-users); and deductive framework analysis expedited the research processes. There were no data on costs.

CONCLUSION

There are a wide range of methods that can be used to deliver timely information about barriers to access. The methods employed in the articles reviewed tended to use traditional data collection approaches in innovative ways.

Cannabis use as a predictor and outcome of positive and negative affect in college students: An ecological momentary assessment study

BACKGROUND

Reinforcement models identify negative affect (NA) and positive affect (PA) to be important momentary determinants and outcomes of cannabis use. Sensitization and allostatic models further suggest that these mood-cannabis associations are stronger among individuals with more cannabis-related problems. Despite this theoretical background and the fact that cannabis is commonly used for its mood-enhancing effects among college students, surprisingly, little is known about the momentary associations between mood and cannabis use in this population.

AIMS

To examine the associations between (a) momentary within-person variations in NA (worried, stressed, nervous) and PA (happy, enthusiastic, proud, excited) and intention to use cannabis within the next hour, (b) the within-person variations in time elapsed since last cannabis use, amount used and momentary NA and PA, and (c) to test whether cannabis-related problems moderate the stated associations.

METHOD

Eighty, more-than-weekly, cannabis using students at the University of Amsterdam reported on cannabis use, NA and PA three times daily for 14 consecutive days. Mixed-effects models were performed to analyze the dataset.

RESULTS

Within-persons, relatively high PA and low NA were associated with a higher likelihood of intending to use cannabis. Within-persons, more recent and greater amounts of cannabis use were associated with relatively high PA. More recent cannabis use was associated with relatively low NA. Cannabis-related problems did not moderate the associations.

CONCLUSIONS

While recent cannabis use related to higher PA and lower NA, high PA but low NA preceded use, supporting positive reinforcement rather than negative reinforcement in this college sample of regular cannabis users.

Why treatment is not an option: Treatment naïve individuals, suffering from alcohol use disorders’ narratives about alcohol use and treatment seeking

Aims: To investigate the narratives of in- and outpatients at mental health and somatic hospitals, who suffer from alcohol use disorders (AUD) but have never sought AUD treatment. More specifically, to understand how the individuals view their alcohol use and explore their reasons for not seeking treatment. Methods: Individuals suffering from AUD were recruited at somatic and mental health hospitals. The study was qualitative, based on semi-structured individual interviews. A narrative analysis was performed. A total of six patients participated: three recruited at a mental health hospital, three from a somatic hospital. Results: The individuals described how heavy alcohol use had always characterised their lives; it was part of their surroundings and it added to their quality of life. Two narrative forms within the individuals’ stories were identified, in which treatment was considered either as a positive option for others but not relevant for themselves, or as representing a threat to the individuals’ autonomy. The participants expressed that they did not believe treatment was relevant for them, and if necessary, they preferred to deal with their heavy drinking themselves. Conclusions: Our findings indicate that a broad focus is needed if relatively more individuals suffering from AUD should seek treatment, since they – in spite of clearly suffering from AUD – nevertheless see themselves as heavy drinkers and have not even thought of seeking treatment. Thus, it is not (only) a question about the attractiveness of the treatment offer or due to lack of knowledge about treatment options that patients suffering from AUD do not seek treatment.

Comparing Cannabis Use Disorder in the General Population with Cannabis Treatment Seekers Using Multi-Source National Datasets: Who Receives Treatment?

INTRODUCTION

Given the increased prevalence of cannabis use in Ireland and increase in cannabis potency, this study aimed to estimate the size of the potential population in Ireland that may be in need of cannabis treatment and the percentage of people with cannabis use disorder (CUD) who actually access treatment. We also compared the profile of those with CUD in the general population to those who receive treatment for their cannabis use to explore whether certain subgroups are more or less likely to enter treatment.

METHOD

This was a retrospective, multi-source database study. Data were obtained from (1) Ireland's 2014/2015 national general population survey (GPS) on drug use and (2) treatment data from the Irish National Drug Treatment Reporting System (NDTRS) for 2015. The profiles of GPS cases with CUD and NDTRS cases were compared using 2-sided t tests designed for independent samples.

RESULTS

The prevalence of last year cannabis use among adults aged 15 and older was 6.5% and the prevalence of CUD was 2.6%, representing 94,515 of the Irish population. A total of 4,761 cases entered treatment for problem cannabis use. NDTRS treatment cases were significantly more likely than GPS cases to be unemployed (63.7% vs. 26.6%) and have no or primary level only educational attainment (56.3% vs. 21.2%). Over half (53.3%) of NDTRS cases first used cannabis before the age of 15 years, compared to 14.7% of CUD cases in the population.

DISCUSSION/CONCLUSION

Our findings suggest that earlier users and those with more complex or disadvantaged lives are more likely to seek treatment. A broad population health approach that engages multiple sectors such as health, social welfare, and education is recommended to ensure that there is increased opportunity for people with CUD to be identified and signposted towards treatment.

CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial

Background

Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise.

Objective

Through adherence-focused guidance enhancement, we aimed to increase adherence to and the effectiveness of internet-based self-help among cannabis users.

Methods

From July 2016 to May 2019, cannabis users (n=775; male: 406/575, 70.6%, female: 169/575, 29.4%; age: mean 28.3 years) not in treatment were recruited from the general population and were randomly assigned to (1) an adherence-focused guidance enhancement internet-based self-help intervention with social presence, (2) a similar intervention with an impersonal service team, and (3) access to internet as usual. Controls who were placed on a waiting list for the full intervention after 3 months underwent an assessment and had access to internet as usual. The primary outcome measurement was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in common mental disorder symptoms, and intervention adherence. Differences between the study arms in primary and secondary continuous outcome variables at baseline, posttreatment, and follow-up were tested using pooled linear models.

Results

All groups exhibited reduced cannabis-use days after 3 months (social presence: –8.2 days; service team: –9.8 days; internet as usual: –4.2 days). The participants in the service team group (P=.01, d=.60) reported significantly fewer cannabis-use days than those in the internet as usual group; the reduction of cannabis use in the social presence group was not significant (P=.07, d=.40). There was no significant difference between the 2 intervention groups regarding cannabis-use reduction. The service team group also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after 3 months to those in the internet as usual group.

Conclusions

The adherence-focused guidance enhancement internet-based self-help intervention with an impersonal service team significantly reduced cannabis use, cannabis-use disorder, dependence severity, and general anxiety symptoms.

Trial Registration

ISRCTN Registry ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185

Characterizing symptoms of cannabis use disorder in a sample of college students

Since legalization of marijuana in several U.S. states in 2012, there has been concern about increases in the development of cannabis use disorder (CUD). The current study examined rates of CUD in Colorado college students who reported regular marijuana use and assessed a range of factors associated with CUD symptoms, including coping motives, concentrate/dab use, mental health concerns (depression, anxiety), age of regular marijuana use, and alcohol use. College students were recruited from a mid-sized university and completed a baseline assessment that included a marijuana urine screen. Participants reported a median of five CUD symptoms and 90% met criteria for CUD. After adjusting for covariates, age of regular marijuana use was negatively associated with number of CUD symptoms, while average daily alcohol drinks was positively associated with number of symptoms. Prevention and intervention efforts at the university level should be increased to reduce negative outcomes associated with problem marijuana use.

The Effects of Social Presence on Adherence-Focused Guidance in Problematic Cannabis Users: Protocol for the CANreduce 2.0 Randomized Controlled Trial

Background

In European countries, including Switzerland, cannabis is the most commonly used illicit drug. Offering a Web-based self-help tool could potentially reach users who otherwise would not seek traditional help. However, such Web-based self-help tools often suffer from low adherence.

Objective

Through adherence-focused guidance enhancements, the aim of this study was to increase adherence in cannabis users entering a Web-based self-help tool to reduce their cannabis use and, in this way, augment its effectiveness.

Methods

This paper presents the protocol for a three-arm randomized controlled trial (RCT) to compare the effectiveness of (1) an adherence-focused, guidance-enhanced, Web-based self-help intervention with social presence; (2) an adherence-focused, guidance-enhanced, Web-based self-help intervention without social presence; and (3) a treatment-as-usual at reducing cannabis use in problematic users. The two active interventions, each spanning 6 weeks, consist of modules designed to reduce cannabis use and attenuate common mental disorder (CMD) symptoms, including depression, anxiety, and stress-related disorder symptoms based on the approaches of motivational interviewing and cognitive behavioral therapy. With a target sample size of 528, data will be collected at baseline, 6 weeks, and 3 months after baseline. The primary outcome measurement will be the number of days of cannabis use on the preceding 7 days. Secondary outcomes will include the quantity of cannabis used in standardized cannabis joints, the severity of cannabis dependence, changes in CMD symptoms, and adherence to the program. Data analysis will follow the intention-to-treat principle and employ (generalized) linear mixed models.

Results

The project commenced in August 2016; recruitment is anticipated to end by December 2018. First results are expected to be submitted for publication in summer 2019.

Conclusions

This study will provide detailed insights on if and how the effectiveness of a Web-based self-help intervention aiming to reduce cannabis use in frequent cannabis users can be improved by theory-driven, adherence-focused guidance enhancement.

Trial Registration

International Standard Randomized Controlled Trial Number Registry: ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185 (Archived by WebCite at http://www.webcitation.org/6wspbuQ1M)

BSAFER: A Web-based intervention for drug use and intimate partner violence demonstrates feasibility and acceptability among women in the emergency department

BACKGROUND

Addressing violence along with drug use change goals is critical for women with coexisting intimate partner violence (IPV) and substance use disorders (SUDs).

METHODS

This was an acceptability and feasibility study of BSAFER, a brief Web-based program and booster phone call addressing violence and drug use. A screening survey identified women with recent drug use and IPV in the emergency department (ED). Participants were randomized to BSAFER or a Web-based control program and booster call providing education about home fire safety. Program completion, usability, satisfaction, and motivational interviewing (MI) adherence were primary outcomes. Drug use and IPV outcomes were measured at baseline, 1 month, and 3 months.

RESULTS

Forty women were enrolled (21 BSAFER, 19 control); 50% were nonwhite and mean age was 30 years. The most commonly used drugs were marijuana (88%) and cocaine (30%); 45% reported physical abuse, and 33% reported severe combined physical and sexual abuse. Thirty-nine (98%) completed the Web program, 30 (75%) completed the booster, and 29 (73%) completed the 3-month follow-up. Mean System Usability Scale (SUS) for the BSAFER Web program was 84 (95% confidence interval [CI]: 78-89) of 100; mean Client Satisfaction Questionnaire (CSQ-8) was 28 (95% CI: 26-29) of 32. MI adherence scores were high and similar for both the Web program and the booster. Both intervention and control groups had small mean decreases in weekly drug use days (0.7 vs. 1.5 days); participants using drugs other than marijuana demonstrated greater average reductions in drug use than those using marijuana only.

CONCLUSIONS

An ED Web-based intervention for SUDs and IPV in women demonstrated feasibility and acceptability. Future studies will examine efficacy of the BSAFER program and investigate whether specific subgroups of drug using women may be most responsive to ED-based Web interventions.

Contingency management for substance use disorders in Spain: Implications for research and practice

OBJECTIVE

We provide a narrative review of published studies evaluating voucher-based contingency management (CM) treatment for cocaine, nicotine and cannabis use disorders in Spain and discuss the concerns and future challenges.

METHOD

Published studies between 2008 and 2015 that evaluated the impact of incentives for SUD in Spain and included an appropriate control or comparison condition were identified and reviewed.

RESULTS

Adding voucher-based CM to standard treatments obtained better treatment retention and cocaine abstinence than standard care alone. CM also improved psychosocial functioning. Economic status or depressive symptoms did not affect the results of CM treatment for cocaine dependence. The addition of a CM protocol to cognitive behavioral treatment (CBT) also improved treatment effectiveness for smoking cessation. Available data on the effect of CM on cannabis use disorders (CUD) with young people did not allow confirmation of its superiority to date.

CONCLUSION

The research conducted to date in Spain confirms and expands the findings of studies conducted in the US supporting the effectiveness of CM in the context of community settings with cocaine- and nicotine-dependents. However, CM has not yet been readily adopted into general clinical practice in Spain or the rest of Europe. The limited effectiveness of CM for CUD is likely due to the scarcity of data and may change with more studies, taking into account recent research on this topic in the US. Continued efforts are warranted to further develop and disseminate incentive-based treatments for SUD across clinical settings and populations in Spain.

mHealth App for Cannabis Users: Satisfaction and Perceived Usefulness

OBJECTIVE

The aim of this study was to describe the characteristics of cannabis users and their levels of satisfaction with Stop-cannabis, an app intended for cannabis users who want to stop or reduce their cannabis use or prevent relapse.

METHODS

A cross-sectional online survey was administered to users of Stop-cannabis, a French-language app for iOS and Android devices. All app users were invited to participate in the survey via a message sent to the app.

RESULTS

For hundred and eighty-two users answered the survey. The app was used daily by 348 of the participants (around 70%). More than 80% of participants (397) considered the app to have helped them "a little" or "a lot" to stop or reduce cannabis consumption. Most of the users' suggestions were related to the number or the quality of the messages sent by, or displayed in, the app.

CONCLUSION

This pilot study supports the feasibility of such an app and its perceived usefulness. A self-selection bias, however, limits the conclusions of the study. The efficacy of the app should be evaluated in a randomized controlled trial.

The link between dopamine function and apathy in cannabis users: an [18F]-DOPA PET imaging study

RATIONALE

Cannabis is the most widely used illicit drug in the world, and regular use has been associated with reduced motivation, i.e. apathy. Regular long-term cannabis use has been associated with reduced dopamine synthesis capacity. The mesolimbic dopaminergic system mediates the processing of incentive stimuli by modifying their motivational value, which in turn is modulated by endocannabinoid signalling. Thus, it has been proposed that dopaminergic dysfunction underlies the apathy associated with chronic cannabis use.

OBJECTIVES

The aim of this study was to examine the relationship between dopaminergic function and subjective apathy in cannabis users.

METHODS

We measured dopamine synthesis capacity (indexed as the influx rate constant K i(cer)) via 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine positron emission tomography and subjective apathy using the self-rated Apathy Evaluation Scale (AES-S) in 14 regular cannabis users.

RESULTS

All subjects scored in excess of 34 points on the AES-S (median [interquartile range] 59.5 [7.5]), indicative of significant apathy based on normative data. K i (cer) was inversely correlated to AES-S score in the whole striatum and its associative functional subdivision (Spearman's rho = -0.64, p = 0.015 [whole striatum]; rho = -0.69, p = 0.006 [associative]) but not in the limbic or sensorimotor striatal subdivisions. There were no significant relationships between AES-S and current cannabis consumption (rho = 0.28, p = 0.34) or age of first cannabis use (rho = 0.25, p = 0.40).

CONCLUSIONS

These findings indicate that the reduction in striatal dopamine synthesis capacity associated with chronic cannabis use may underlie reduced reward sensitivity and a motivation associated with chronic cannabis use.

Comorbid psychiatric disorders and stages of change in cannabis-dependent, treatment-seeking patients

OBJECTIVES

To determine whether and to what extent cannabis dependence is associated with comorbid psychiatric disorders and specific stages of change in treatment-seeking patients.

METHODS

We evaluated 80 cannabis-dependent, treatment-seeking patients residing in an urban area. Data on cannabis dependence, psychiatric disorders, and motivation were obtained using the Schedules for Clinical Assessment in Neuropsychiatry and the University of Rhode Island Change Assessment (URICA).

RESULTS

A diagnosis of schizophrenia was found to correlate with lower motivation scores (p = 0.038), which could have a negative effect on adherence to treatment.

CONCLUSION

The high prevalence of concurrent psychiatric disorders in cannabis-dependent patients should serve as a stimulus for early screening and treatment of such disorders. Health care professionals should be aware of the magnitude of this association to increase the level of motivation in cannabis-dependent patients with severe concurrent psychiatric disorders.

Attitudes towards alcohol dependence and affected individuals: persistence of negative stereotypes and illness beliefs between 1990 and 2011

BACKGROUND

Alcohol dependence is among the most severely stigmatized mental disorders. We examine whether negative stereotypes and illness beliefs related to alcohol dependence have changed between 1990 and 2011.

METHODS

We used data from two population surveys with identical methodology that were conducted among German citizens aged ≥18 years, living in the 'old' German states. They were conducted in 1990 and 2011, respectively. In random subsamples (1990: n = 1,022, and 2011: n = 1,167), identical questions elicited agreement with statements regarding alcohol dependence, particularly with regard to the illness definition of alcohol dependence and blame.

RESULTS

Overall, agreement with negative stereotypes did not change in the course of 2 decades. About 55% of the respondents agreed that alcohol dependence is an illness like any other, >40% stated that it was a weakness of character and 30% endorsed that those affected are themselves to blame for their problems.

CONCLUSIONS

It is apparent that promoting an illness concept of alcohol dependence has not been an easy solution to the problem of stigma. We discuss how the normative functions of alcohol dependence stigma might have prevented a reduction of negative stereotypes.

CANDIS treatment program for cannabis use disorders: findings from a randomized multi-site translational trial

BACKGROUND

In a recent paper, we reported the efficacy of a modular cognitive-behavioral intervention for treating adolescents and adults with cannabis use disorders (CUD). In this study, we examine the outcome of this intervention after translating it into clinical practice.

METHODS

A multi-site, randomized controlled trial of 279 treatment seekers with ICD-10 cannabis use disorders aged 16- 63 years was conducted in 11 outpatient addiction treatment centers in Germany. Patients were randomly assigned to an Active Treatment (AT, n=149) or Delayed Treatment Control (DTC, n=130). Treatment consisted of 10 sessions of fully manualized individual psychotherapy that combined Cognitive-Behavioral Therapy, Motivational EnhancementTherapy and problem-solving training. Assessments were conducted at baseline, during each therapy session, at post-treatment and at three and six month follow-ups.

RESULTS

At post assessment 53.3% of AT patients reported abstinence (46.3% negative urine screenings) compared to 22% of DTC patients (17.7% negative drug screenings) (p<0.001, Intention-to-treat analysis). AT patients improved in the frequency of cannabis use, number of cannabis dependence criteria, severity of dependence, as well as number and severity of cannabis-related problems. Effect sizes were moderate to high. While abstinence rates in the AT group decreased over the 3-month (negative urine screenings: 32.4%) and 6-month (negative urine screenings: 35.7%) follow-up periods, the effects in secondary outcomes were maintained.

CONCLUSIONS

The intervention can successfully be translated to and applied in clinical practice. It has the potential to improve access to evidence-based care for chronic CUD patients.

Can reduce--the effects of chat-counseling and web-based self-help, web-based self-help alone and a waiting list control program on cannabis use in problematic cannabis users: a randomized controlled trial

BACKGROUND

In European countries, including Switzerland, as well as in many states worldwide, cannabis is the most widely used psychoactive substance after alcohol and tobacco. Although approximately one in ten users develop serious problems of dependency, only a minority attends outpatient addiction counseling centers. The offer of a combined web-based self-help and chat counseling treatment could potentially also reach those users who hesitate to approach such treatment centers and help them to reduce their cannabis use.

METHODS/DESIGN

This paper presents the protocol for a three-armed randomized controlled trial that will test the effectiveness of a web-based self-help intervention in combination with, or independent of, tailored chat counseling compared to a waiting list in reducing or enabling the abstention from cannabis use in problematic users. The primary outcome will be the weekly quantity of cannabis used. Secondary outcome measures will include the number of days per week on which cannabis is used, the severity of cannabis use disorder, the severity of cannabis dependence, cannabis withdrawal symptoms, cannabis craving, the use of alcohol, tobacco, and other non-cannabis illicit drugs, changes in mental health symptoms, and treatment retention. The self-help intervention will consist of 8 modules designed to reduce cannabis use based on the principles of motivational interviewing, self-control practices, and methods of cognitive behavioral therapy. The two additional individual chat-counseling sessions in the additional chat condition will be based on the same therapy approaches and tailored to participants' self-help information data and personal problems. The predictive validity of participants' baseline characteristics on treatment retention and outcomes will be explored.

DISCUSSION

To the best of our knowledge, this will be the first randomized controlled trial to test the effectiveness of online self-help therapy in combination or without chat counseling in reducing or enabling the abstention from cannabis use. It will also investigate predictors of outcome and retention for these interventions. This trial is registered at Current Controlled Trials and is traceable as ISRCTN59948178.

Problembewusstsein und Inanspruchnahme von Hilfe bei substanzbezogenen Problemen

Ziel: Es wurden 12-Monats-Prävalenzen geschätzt bezüglich a) der Wahrnehmung substanzbezogener Probleme, b) der Inanspruchnahme verschiedener Hilfsangebote und c) der Inanspruchnahme professioneller Hilfe. Faktoren, die mit der Inanspruchnahme von Hilfe assoziiert sind, wurden analysiert. Methodik: Die Auswertung basiert auf Daten des Epidemiologischen Suchtsurveys (ESA) 2012 (n = 9084; 18 – 64 Jahre; Ausschöpfungsrate 53.6 %). Missbrauch und Abhängigkeit nach DSM-IV wurden anhand des M-CIDI erfasst. Prädiktoren der Hilfesuche wurden regressionsanalytisch getestet. Ergebnisse: Zwischen 6 % (Alkohol) und 19 % (illegale Drogen) der Konsumenten berichteten substanzbezogene Probleme. Von diesen nahmen 14 % (Alkohol), 33 % (Illegale Drogen) bzw. 59 % (Medikamente) Hilfe in Anspruch. Mit Ausnahme des Einkommens bei Alkoholkonsumenten waren soziodemografische Variablen nicht mit der Inanspruchnahme von Hilfe assoziiert. Schlussfolgerungen: Die Studie zeigt eine Unterversorgung von Personen mit substanzbezogenen Problemen. Das Hilfesuchverhalten scheint hauptsächlich durch die Schwere der substanzbezogenen Störung beeinflusst zu sein.