Department of Economics and Business Economics

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

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DOI

  • Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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  • Meyer Glantz, Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
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  • Sara Evans-Lacko, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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  • Ekaterina Sadikova, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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  • Nancy Sampson, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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  • Graham Thornicroft, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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  • Sergio Aguilar-Gaxiola, Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
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  • Ali Al-Hamzawi, College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq.
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  • Jordi Alonso, Health Services Research Unit, Hospital del Mar Medical Research Institute; Pompeu Fabra University; and CIBER en Epidemiología y Salud Pública, Barcelona, Spain.
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  • Laura Helena Andrade, Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
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  • Ronny Bruffaerts, Campus Gasthuisberg, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium.
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  • Brendan Bunting, School of Psychology and Psychology Research Institute, Ulster University, Magee campus, Londonderry, Northern Ireland, UK.
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  • Evelyn J Bromet, Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA.
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  • José Miguel Caldas de Almeida, Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal.
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  • Giovanni de Girolamo, 1] Laboratory of Neuropsychopharmacology and Functional Neurogenomics-Dipartimento di Scienze Farmacologiche e Biomolecolari and CEND, Università di Milano, Milano, Italy [2] IRCCS San Giovanni di Dio-Fatebenefratelli, Brescia, Italy.
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  • Silvia Florescu, National School of Public Health, Management and Professional Development, Bucharest, Romania.
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  • Oye Gureje, Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
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  • Josep Maria Haro, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
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  • Yueqin Huang, Institute of Mental Health, Peking University, Beijing, China.
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  • Aimee Karam, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
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  • Elie G Karam, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon.
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  • Andrzej Kiejna, Wroclaw Medical University, University of Lower Silesia, Wroclaw, Poland.
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  • Sing Lee, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
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  • Jean-Pierre Lepine, Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, Paris Diderot and Paris Descartes Universities, Paris, France.
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  • Daphna Levinson, Mental Health Services, Ministry of Health, Israel.
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  • Maria Elena Medina-Mora, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
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  • Yosikazu Nakamura, Department of Public Health, Jichi Medical University, Shimotsuke, Japan.
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  • Fernando Navarro-Mateu, UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain.
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  • Beth-Ellen Pennell, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48104, USA.
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  • José Posada-Villa, Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
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  • Kate Scott, Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
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  • Dan J Stein, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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  • Margreet Ten Have, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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  • Yolanda Torres, Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
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  • Zahari Zarkov, Directorate for Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria.
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  • Somnath Chatterji, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.
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  • Ronald C Kessler, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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  • World Health Organization's World Mental Health Surveys collaborators

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.

Original languageEnglish
JournalWorld Psychiatry
Volume16
Issue3
Pages (from-to)299-307
Number of pages9
ISSN1723-8617
DOIs
Publication statusPublished - Oct 2017

    Research areas

  • ALCOHOL-USE DISORDERS, BARRIERS, CANNABIS USE, CARE, DEPENDENCE, INJECTING DRUG-USERS, ONSET, SERVICES, Substance use disorders, United Nations Sustainable Development Goals, VERSION, World Health Organization, alcohol, drugs, treatment coverage

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