School of Public Health, The University of Queensland, Herston, QLD, Australia.
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD, Australia.
Addiction. 2019 Aug;114(8):1446-1459. doi: 10.1111/add.14599. Epub 2019 Jun 2.
To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity.
Cross-sectional, representative household surveys.
Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative.
A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence).
Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes.
Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries.
Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.
研究 12 个月物质使用障碍（SUD）治疗和最低充分治疗（MAT）的跨国模式，并探讨其与精神障碍共病的关系。
横断面、代表性家庭调查。
世界卫生组织世界心理健康调查倡议的 25 个国家的 27 项调查。
共有 2446 名过去一年有 DSM-IV SUD 诊断（酒精或非法药物滥用和依赖）的人。
结果是 SUD 治疗，定义为过去 12 个月内接受过专业治疗或参加过与物质相关问题的自助小组；MAT，定义为接受过 4 次或更多次 SUD 治疗，每次都由医疗保健专业人员进行，或接受过 6 次或更多次非医疗保健专业人员的治疗，或在采访时正在接受治疗。协变量为精神障碍共病和几个社会经济特征。汇总估计反映了国家样本量，而不是人口规模。
在过去一年有 SUD 的受访者中，有 11.0%（标准误差 [SE] = 0.8）接受了过去 12 个月的 SUD 治疗。与单纯 SUD 患者相比，有精神障碍共病的患者接受 SUD 治疗的比例更高（18.1%，SE = 1.6 对 6.8%，SE = 0.7），MAT（84.0%，SE = 2.5 对 68.3%，SE = 3.8）和接受医疗保健专业人员治疗的比例（88.9%，SE = 1.9 对 78.8%，SE = 3.0）也更高。在接受 SUD 治疗的病例中，调整社会经济特征后，精神障碍共病使 SUD 治疗的可能性增加了一倍（比值比 [OR] = 2.34；95%置信区间 [CI] = 1.71-3.20），MAT 的可能性也增加了（OR = 2.75；95% CI = 1.90-3.97），接受治疗的病例的 MAT 也增加了（OR = 2.48；95% CI = 1.23-5.02）。在不同国家收入群体中，这些模式相似，尽管高收入国家接受 SUD 治疗和 MAT 的比例高于低收入/中等收入国家。
过去一年有物质使用障碍的人中，很少有人接受充分的 12 个月物质使用障碍治疗，即使与精神障碍共病。这主要是由于接受任何物质使用障碍治疗的比例较低，因为至少接受最低充分治疗的患者比例较高。
