Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys
Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys
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DOI：
10.1002/wps.20457
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发表时间：
2017-10-01
期刊：
影响因子：
73.3
通讯作者：
Kessler, Ronald C.
中科院分区：
文献类型：
--
作者：
Degenhardt, Louisa;Glantz, Meyer;Kessler, Ronald C.
药物使用是全球残疾的主要原因。最近的联合国可持续发展目标（SDG）已认识到这一点，其中将药物滥用障碍的治疗覆盖率确定为指标之一。目前还没有对跨国治疗覆盖率进行估计，因此很难知道该可持续发展目标的基线是什么。我们在此报告世界卫生组织 (WHO) 世界心理健康调查 (WMHS) 的数据，这些数据基于 26 个国家的代表性社区家庭调查。我们评估了物质使用障碍（酒精或药物滥用/依赖）的 12 个月患病率；患有这些疾病的人知道自己需要治疗并希望接受护理的比例；寻求护理并接受护理的人的比例；达到治疗质量最低标准（“最低限度适当治疗”）的此类治疗的比例。在 70,880 名参与者中，2.6% 符合药物滥用障碍 12 个月标准；中高收入国家（3.3%）的患病率高于高收入国家（2.6%）和低收入/中低收入国家（2.0%）。总体而言，患有 12 个月药物滥用障碍的患者中有 39.1% 认识到需要治疗；这种认识在高收入国家（43.1%）比中高收入国家（35.6%）和低收入/中低收入国家（31.5%）更为普遍。在那些认识到治疗需要的人中，61.3%的人至少去过一次服务提供商，其中29.5%的人接受了最低限度的充分治疗（高收入国家为35.3%，中高收入国家为20.3%，低收入/中低收入国家为8.6%）。总体而言，去年患有药物滥用障碍的人中只有 7.1% 接受了最低程度的充分治疗：高收入国家为 10.3%，中高收入国家为 4.3%，低/中低收入国家为 1.0%。这些数据表明，只有一小部分患有物质使用障碍的人接受了哪怕是最低限度的充分治疗。至少涉及三个障碍：意识/感知的治疗需求、一旦认识到需求就获得治疗以及遵守（提供者和客户双方）以获得充分的治疗。这三个障碍中的每一个都可能涉及多种因素，所有这些因素都需要解决，以提高药物滥用障碍的治疗覆盖率。这些数据为全球监测这些疾病的治疗覆盖进展情况提供了基线，作为可持续发展目标的一项指标。
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 uppermiddle (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 receivedminimally 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 globalmonitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.