Pathways into Services for Alcohol and Drug Disorders

描述（由申请人提供）：本申请的目的是加强我们对药物和酒精障碍个人使用的药物和酒精服务途径的理解。公共卫生问题是临床上确定需要服务（药物滥用或依赖）的个人缺乏服务利用，我们将其概念化为未满足的需求。虽然研究已经确定了一系列治疗酒精和药物障碍的有效服务，无论是在初级保健还是专业护理中，但很少有患有这些疾病的人接受服务。我们广泛地将物质使用服务概念化，包括初级保健， 特殊物质使用服务和自助团体。此外，虽然从历史上的酒精/药物和心理健康的研究领域一般只涉及一个特定的服务部门，我们建议研究药物滥用服务，心理健康服务和初级保健服务之间的相互作用，最终重点是药物滥用服务。 我们通过对三项具有全国代表性的大型调查进行二次分析来调查这些问题：全国酒精和相关疾病流行病学调查（NESARC），社区卫生保健（HCC）和全国药物使用和健康调查（NSDUH）。具体目标是：（1）调查对药物和酒精服务的感知需求的模式和预测因素，以及感知需求和接受物质使用障碍（SUD）服务之间的关系;（2）调查药物和酒精问题的初级保健筛查的模式和预测因素，以及筛查与初级保健物质滥用服务和专科转诊的关系;（3）调查物质障碍患者使用精神卫生服务的模式和预测因素，以及这与接受物质滥用服务的关系;（4）调查SUD患者接受“强迫”或“非自愿”SUD服务的模式和预测因素;（5）调查种族/民族和城市/农村在进入SUD服务途径方面的差异。研究结果将为政策提供信息，以提高药物滥用障碍患者对有效药物滥用服务的利用率。

DESCRIPTION (provided by applicant): The purpose of this application is to enhance our understanding of the pathways into drug and alcohol services utilized by individuals with drug and alcohol disorders. Of public health concern is the lack of services utilization among individuals with clinically defined need for services (substance abuse or dependence), which we conceptualize as unmet need. While research has identified a range of effective services for treating alcohol and drug disorders, both in primary care and specialty care, few individuals with these disorders receive services. We conceptualize substance use services broadly, including primary care, specialty substance use services, and self-help groups. Further, while historically the alcohol/drug and mental health research fields have generally addressed only a particular service sector, we propose to study the interactions among substance abuse services, mental health services, and primary care services, with the ultimate focus on substance abuse services. We investigate these issues through secondary analysis of three large, nationally representative surveys: the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), Health Care for Communities (HCC) and the National Survey of Drug Use and Health (NSDUH). The Specific Aims are: (1) To investigate patterns and predictors of perceived need for drug and alcohol services, and the relationship between perceived need and receipt of substance use disorders (SUD) services; (2) To investigate patterns and predictors of primary care screening for drug and alcohol problems, and how screening relates to primary care substance abuse services and specialty referral; (3) To investigate patterns and predictors of mental health services utilization among individuals with substance disorders, and how this relates to receipt of substance abuse services; (4) to investigate patterns and predictors of "coerced" or "non-voluntary" SUD services among individuals with SUDs; (5) to investigate racial/ethnic and urban/rural differences in pathways into SUD services. The results of the study will inform policy to increase rates of utilization of effective substance abuse services among those with substance use disorders.