Pathways into Services for Alcohol and Drug Disorders

描述(申请人提供)：本申请的目的是加强我们对药物和酒精障碍患者利用药物和酒精服务的途径的了解。公共卫生关注的一个问题是，具有临床确定的服务需求(药物滥用或依赖)的个人缺乏服务利用，我们将其定义为未得到满足的需求。虽然研究已经确定了一系列有效的治疗酒精和药物障碍的服务，包括初级保健和专科护理，但很少有患有这些障碍的人得到服务。我们广泛地概念化物质使用服务，包括初级保健， 特殊物质使用服务和自助小组。此外，虽然历史上酒精/药物和精神健康研究领域通常只涉及特定的服务部门，但我们建议研究药物滥用服务、精神健康服务和初级保健服务之间的相互作用，最终将重点放在药物滥用服务上。 我们通过对三项具有全国代表性的大型调查的二次分析来调查这些问题：全国酒精及相关疾病流行病学调查(NESARC)、社区卫生保健(HCC)和全国药物使用与健康调查(NSDUH)。具体目标是：(1)调查药物和酒精服务感知需求的模式和预测因素，以及感知需求与接受药物使用障碍(SUD)服务之间的关系；(2)调查药物和酒精问题初级保健筛查的模式和预测因素，以及筛查与初级保健药物滥用服务和专科转介之间的关系；(3)调查药物障碍患者利用精神卫生服务的模式和预测因素，以及这与接受药物滥用服务之间的关系；(4)调查药物使用障碍患者中“强迫”或“非自愿”SUD服务的模式和预测因素；(5)调查进入南部非洲服务的途径的种族/民族和城乡差异。这项研究的结果将为提高药物使用障碍患者有效药物滥用服务利用率的政策提供参考。

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.