Perceived need for treatment among pregnant and nonpregnant women arrestees

The role of consumer perspectives in estimating population need for substance use services: a scoping review

Background

A growing body of research assesses population need for substance use services. However, the extent to which survey research incorporates expert versus consumer perspectives on service need is unknown. We conducted a large, international review to (1) describe extant research on population need for substance use services, and the extent to which it incorporates expert and consumer perspectives on service need, (2) critically assess methodological and measurement approaches used to study consumer-defined need, and (3) examine the potential for existing research that prioritizes consumer perspectives to inform substance use service system planning.

Methods

Systematic searches of seven databases identified 1930 peer-reviewed articles addressing population need for substance use services between January 1980 and May 2015. Empirical studies (n = 1887) were categorized according to source(s) of data used to derive population estimates of service need (administrative records, biological samples, qualitative data, and/or quantitative surveys). Quantitative survey studies (n = 1594) were categorized as to whether service need was assessed from an expert and/or consumer perspective; studies employing consumer-defined need measures (n = 217) received further in-depth quantitative coding to describe study designs and measurement strategies.

Results

Almost all survey studies (96%; n = 1534) used diagnostically-oriented measures derived from an expert perspective to assess service need. Of the small number (14%, n = 217) of survey studies that assessed consumer’s perspectives, most (77%) measured perceived need for generic services (i.e. ‘treatment’), with fewer (42%) examining self-assessed barriers to service use, or informal help-seeking from family and friends (10%). Unstandardized measures were commonly used, and very little research was longitudinal or tested hypotheses. Only one study used a consumer-defined need measure to estimate required service system capacity.

Conclusions

Rhetorical calls for including consumer perspectives in substance use service system planning are belied by the empirical literature, which is dominated by expert-driven approaches to measuring population need. Studies addressing consumer-defined need for substance use services are conceptually underdeveloped, and exhibit methodological and measurement weaknesses. Further scholarship is needed to integrate multidisciplinary perspectives in this literature, and fully realize the promise of incorporating consumer perspectives into substance use service system planning.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2153-z) contains supplementary material, which is available to authorized users.

Pregnancy and fetal loss reported by methamphetamine-using women

To better understand substance use disorder treatment needs of pregnant and parenting women who use methamphetamine (MA), this paper describes pregnancy histories and fetal losses for women who were treated for MA use (N = 153) with reference to a national sample, and describes their drug use, sexual risk behaviors, and mental health status. MA users reported an average of 4.6 total pregnancies and 2.1 fetal losses, whereas women in a general population survey reported 3.2 and 1.2, respectively. Higher numbers of pregnancies and fetal losses were correlated with specific substance abuse and mental health problems including early sexual abuse and cognitive problems. The combination of MA users' especially high numbers of pregnancies, fetal losses, and rates of risk behaviors suggest high social and health care costs for this population. Prenatal care may provide a vector through which women can be connected to risk reduction interventions and gender-responsive treatment services addressing substance use and mental health needs.

Perceived need for substance abuse treatment among illicit stimulant drug users in rural areas of Ohio, Arkansas, and Kentucky

Non-medical drug use in rural communities in the United States is a significant and growing public health threat. Understanding what motivates drug users in rural areas to seek substance abuse treatment may help in addressing the problem. Perceived need for treatment, a construct indicative of problem recognition and belief in problem solution, has been identified as an important predictor of help-seeking behavior. This cross-sectional study used data collected through face-to-face interviews to examine factors associated with perceived need for drug abuse treatment among not-in-treatment, adult, illicit stimulant drug users (n=710) in rural areas of Ohio, Kentucky, and Arkansas. More than one-quarter of the sample perceived a need for treatment. Results from a stepwise multiple regression analysis showed that white users, users with better physical and mental health status, and occasional users of methamphetamine were significantly less likely to see a need for treatment. Users with higher Addiction Severity Index composite scores for family/social problems or legal problems, and users with prior drug abuse treatment experience were significantly more likely to perceive a need for treatment. These findings have practical implications for efforts addressing substance abuse in rural areas.

Self-reported health status among treated methamphetamine users

Very little research has examined how drug abuse is related to general health status over the long term among both young and middle-aged adults. In this article, we investigate how self-reported health status is related to prolonged methamphetamine (MA) use in a diverse sample of MA users from ages 18 to 52 who have been treated for drug abuse in Los Angeles County. Using retrospective data, we investigate how prolonged MA use within younger and older age groups is related to two self-reported measures of current health status: the presence of a health condition that began after starting illegal drug use, and overall health. We control for the effects of drug use history, social and demographic factors, and other early experiences (e.g., early sexual abuse) that might be obstacles to achieving good health later in life. We find that having a current health condition is predicted by greater age and by more prolonged MA use, especially among younger people. Early sexual abuse predicts both measures of poor health. Current health status is predicted by several measures of drug use history and early experiences, but by fewer social and demographic factors. The results suggest that reduction of MA use among younger people is important in promoting their later health and that MA treatment services could be improved by a greater understanding of how early experiences influence later health.

The drug court. A new strategy for drug use prevention

The concept of Drug Treatment Court is relatively new and is an innovative response by local communities to deal with the escalation of criminal activity associated with substance abuse. The frequency of repeated offenses by drug users, the overcrowding of jail space, and a diminished sense of community well-being contributed to the motivation to look for a new approach by the criminal justice system--the creation of Drug Treatment Courts. This article reviews the strategy behind this creation.