Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
BMC Health Serv Res. 2024 Aug 22;24(1):970. doi: 10.1186/s12913-024-11304-5.
The treatment gap for addictive disorders is one of the largest in health care. Several studies have investigated barriers to treatment for different addictive disorders, but very few studies conducted have explored whether the barriers differ depending on substance or behavior or if they are common among all addictive disorders. In Sweden, addiction care is provided both by the healthcare and social services, where the latter is common, but also less popular. To our knowledge, there are no studies exploring whether the barriers are different depending on where the treatment is given.
The aim was to thoroughly explore both which general and social services-specific barriers to treatment that are common, which barriers that differs, and how the barriers are described among individuals with a problematic use of alcohol, cannabis and/or gambling.
A mixed method convergent parallel design was conducted. For the quantitative measures, surveys including the validated Barriers to Treatment Inventory as well as questions regarding barriers in the Swedish multi-provider landscape, were collected from individuals with a problematic use of alcohol (n = 207), cannabis (n = 51), and gambling (n = 37). In parallel, 17 semi-structured interviews from the same population were conducted and analyzed with thematic analysis. Thereafter, the quantitative and qualitative data was compared, contrasted, and at last, interpreted.
The quantitative data showed that the largest general barriers in all groups were privacy concern and poor availability, and the largest barriers for seeking help from the social services was stigma, unawareness of what is offered, and fear of consequences for all groups. The qualitative data resulted in five general barriers: stigma, ambivalence, accessibility, fear of consequences, and lack of knowledge about addiction and its' treatments, and three barriers specifically towards social services: social services reputation, fear of meeting acquaintances, and lack of knowledge. The themes were developed from data from all groups, but different aspects of the themes were mentioned by different groups.
There are details and aspects that differentiates both the general and social service-specific barriers to treatment between individuals with a problematic use of alcohol, cannabis, and gambling, but in large they perceive similar barriers.
成瘾障碍的治疗差距是医疗保健中最大的差距之一。已经有几项研究调查了不同成瘾障碍治疗的障碍，但很少有研究探讨这些障碍是否因物质或行为而异，或者它们是否在所有成瘾障碍中普遍存在。在瑞典，医疗保健和社会服务都提供成瘾治疗，后者比较常见，但也不太受欢迎。据我们所知，没有研究探讨治疗障碍是否因治疗地点而异。
本研究旨在深入探讨普遍存在的一般障碍和社会服务特定障碍，以及不同的障碍，以及个体在酒精、大麻和/或赌博方面存在问题时对这些障碍的描述。
采用混合方法(convergent parallel design)，包括问卷调查和半结构化访谈。对于定量测量，我们从有酒精（n=207）、大麻（n=51）和赌博问题（n=37）的个体中收集了包括验证后的治疗障碍量表在内的调查，以及关于瑞典多提供者环境中的障碍的问题。同时，从同一人群中进行了 17 次半结构化访谈，并进行主题分析。然后，对定量和定性数据进行比较、对比和解释。
定量数据显示，所有组中最大的一般障碍是隐私问题和可用性差，而寻求社会服务帮助的最大障碍是污名化、对所提供服务的认识不足以及对所有组的后果的恐惧。定性数据产生了五个一般障碍：污名化、矛盾心理、可及性、对后果的恐惧以及对成瘾及其治疗的了解不足，以及三个针对社会服务的特定障碍：社会服务声誉、害怕遇到熟人以及缺乏知识。这些主题是从所有组的数据中开发出来的，但不同组提到了主题的不同方面。
酒精、大麻和赌博问题个体之间存在治疗障碍的细节和方面的差异，但总体上他们认为存在相似的障碍。
