Patterns and predictors of treatment seeking after onset of a substance use disorder.

BACKGROUND: We studied survey respondents aged 18 through 54 years to determine consistent predictors of treatment seeking after onset of a DSM-III-R substance use disorder. METHODS: Survey populations included a regional sample in Ontario (n = 6261), a national sample in the United States (n = 5388), and local samples in Fresno, Calif (n = 2874) and Mexico City, Mexico (n = 1734). The analysis examined the effects of demographics, symptoms, and types of substances on treatment seeking. RESULTS: Between 50% (Ontario) and 85% (Fresno) of people with substance use disorders seek treatment but the time lag between onset and treatment seeking averages a decade or more. Consistent predictors of treatment seeking include: (1) late onset of disorder (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.6-5.6 for late [> or =30 years] vs early [1-15 years] age at first symptom of disorder); (2) recency of cohort (OR, 3.4; 95% CI, 2.3-5.0 for most recent [aged 15-24 years at interview] vs earliest [aged > or =45 years] cohorts); (3) 4 specific dependence symptoms (using larger amounts than intended, unsuccessful attempts to cut down use, tolerance, and withdrawal symptoms), with ORs ranging between 1.6 (95% CI, 1.3-2.0) and 2.7 (95% CI, 2.1-3.6) for people with vs without these symptoms; and (4) use vs nonuse of cocaine (OR, 2.1; 95% CI, 1.6-2.7) and heroin (OR, 2.6; 95% CI, 1.1-6.0). CONCLUSIONS: Although most people with substance use disorders eventually seek treatment, treatment seeking often occurs a decade or more after the onset of symptoms of disorder. While treatment seeking has increased in recent years, it is not clear whether this is because of increased access, increased demand, increased societal pressures, or other factors.

[Gender differences in alcohol consumption in Mexico City]. / Diferencias por género en el consumo de alcohol en la Ciudad de México.

OBJECTIVE: The objectives of the present study were: 1) To corroborate the increase in alcohol consumption in the female population registered by results from the National Surveys on Addictions (ENA), 1988 and 1993; and 2) to determine affected age groups, and obtain basic information on age of onset, amount consumed per event and drunkenness frequency in the adult population of Mexico City, as indicators to orient preventive measures. MATERIAL AND METHODS: A multi-stage, stratified household survey was applied. A total of 1,932 interviews was completed, subjects were between 18 and 65 years of age, with a response rate of 60.4%. The instrument was a modified version of the Composite International Psychiatric Interview (CIDI), which is a highly structured instrument, applicable by non-specialized personnel, although limited training is necessary. The alcohol section included questions on the age of the first drink, the frequency and amount consumed during each event and the drunkenness frequency during the last 12 months, among other variables. Median and percentage were obtained by sex and among age-cohorts. RESULTS: Of the total, 96.5% of men and 18.1% of women have consumed at least one drink in their lives. In average, age of onset is 16 years for men, and 18 years for women. Age group comparisons show a clear tendency to begin drinking at an earlier age, particularly in women. The growing trend indicated by ENA with respect to alcohol consumption in the feminine population and at a younger age was corroborated. Results indicated that, in average, 5 years after the age of onset, both men and women reach their highest quantities of alcohol consumption, which tend to be excessive. Additionally, high-risk drinking among women (five or more drinks per event) increased to be four times higher in a period of seven years, and with an apparent tendency to rise. Sixty percent of the drinking population reduced alcohol consumption before the age of 30, however, the remaining 40% continued to drink at the same rate, or even increased consumption, particularly among women. CONCLUSIONS: The age of onset of alcohol consumption has diminished, especially in women, showing tendencies towards abuse. Preventive programs should predominantly focus on young age groups with emphasis on the feminine population.

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.