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      Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand

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      , Ph.D. a , * , , B.Psyc.Sc.(HONS.) a , , Ph.D. a , , Ph.D. a , , Ph.D. a
      Journal of Studies on Alcohol and Drugs. Supplement
      Rutgers University

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          Abstract

          Objective:

          Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners.

          Method:

          A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date.

          Results:

          Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available.

          Conclusions:

          Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.

          Objectif :

          L’estimation de l’ampleur du besoin de traitement, défini par la présence d’un diagnostic pour lequel un traitement efficace est disponible, et la demande de traitement, définie par la recherche de traitement, sont des éléments essentiels à une planification efficace du traitement, à la prestation de service et à son financement. Cet article passe en revue la littérature existante sur les approches pour estimer le besoin et la demande ainsi que l’utilisation de modèles pour documenter une telle estimation, puis considère les implications pour les planificateurs des services de santé.

          Méthode :

          Une revue thématique de la littérature a été entreprise en mettant l’accent sur les concepts clés et les méthodes de recherche qui ont été utilisées à ce jour.

          Résultats :

          Les estimations des besoins et de la demande sont toutes deux importantes dans la planification des services, mais constituent des défis importants lors du passage de la théorie de la mesure aux aspects plus pratiques de production de ces estimations. Par ailleurs, la simple estimation d’un nombre lié au besoin ou à la demande est limitée, à moins qu’elle ne soit appariée avec différents types de traitement et leur intensité respective, ou explorée avec d’autres facteurs géographiques et de sous-population. La modélisation aide à produire des estimations de planification plus précises et permet de prendre en compte à la fois la sévérité des problèmes du client et les types de traitement qui pourraient être disponibles.

          Conclusion:

          En partant d’estimations relativement simplistes des besoins et de la demande de traitement, cette revue a montré que si ce genre d’estimation peut éclairer la planification des traitements à l’échelle nationale ou régionale, d’autres modèles plus sophistiqués sont nécessaires pour la planification des traitements des problèmes liés à l’usage d’alcool et des autres drogues. Ceux-ci peuvent aider les planificateurs des services de santé à déterminer la quantité et la combinaison appropriées de traitement pour les troubles liés à l’utilisation de substances.

          Objetivo:

          Las estimaciones de la magnitud de las necesidades de tratamiento, que se define por la presencia de un diagnóstico para el cual existe un tratamiento efectivo disponible, y la demanda de tratamiento, definida como la búsqueda de tratamiento, son parte esencial de la planificación de un tratamiento eficaz, la prestación de servicios y la financiación del tratamiento. Este artículo revisa la literatura existente sobre enfoques para estimar la necesidad y la demanda y el uso de modelos para informar a dicha estimación, y luego considera las implicaciones para los planificadores de salud.

          Método:

          Se realizó una revisión temática de la literatura, con un enfoque en cubrir los conceptos clave y los métodos de investigación que se han empleado hasta la fecha.

          Resultados:

          Tanto la necesidad como la demanda son estimaciones importantes en la planificación de los servicios, pero contienen muchas dificultades para pasar de la teoría de la medición a los aspectos prácticos de establecer estas cifras. Además, el simple quantum de necesidad o demanda es limitado en su utilidad a menos que se corresponda con la consideración de diferentes tipos de tratamiento y su intensidad relativa, y / o explorado como una función de la geografía y la subpoblación. El modelado puede ayudar a establecer estimaciones de planificación más precisas, y puede tener en cuenta tanto la gravedad del cliente como los diversos tipos de tratamiento que podrían estar disponibles.

          Conclusiones:

          Pasando de estimaciones relativamente simplistas de la necesidad y demanda de tratamiento, esta revisión ha demostrado que, si bien dicha estimación puede informar la planificación del tratamiento nacional o subnacional, se requieren modelos más sofisticados para la planificación del tratamiento del alcohol y otras drogas. Estos pueden ayudar a los planificadores de salud a determinar la cantidad apropiada y la combinación de tratamientos para los trastornos por uso de sustancias.

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          Most cited references56

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          Societal and Individual Determinants of Medical Care Utilization in the United States

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            Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys

            The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
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              Is Open Access

              Treatment utilization among persons with opioid use disorder in the United States

              Background The United States is experiencing an opioid overdose epidemic. Treatment use data from diverse racial/ethnic groups with opioid use disorder (OUD) are needed to inform treatment expansion efforts. Methods We examined demographic characteristics and behavioral health of persons aged ≥12 years that met criteria for past-year OUD (n=6,125) in the 2005–2013 National Surveys on Drug Use and Health (N=503,101). We determined the prevalence and correlates of past-year use of alcohol/drug use treatment and opioid-specific treatment to inform efforts for improving OUD treatment. Results Among persons with OUD, 81.93% had prescription (Rx) OUD only, 9.75% had heroin use disorder (HUD) only, and 8.32% had Rx OUD+HUD. Persons with Rx OUD+HUD tended to be white, adults aged 18–49, males, or uninsured. The majority (80.09%) of persons with OUD had another substance use disorder (SUD), and major depressive episode (MDE) was common (28.74%). Of persons with OUD, 26.19% used any alcohol or drug use treatment, and 19.44% used opioid-specific treatment. Adolescents, the uninsured, blacks, native-Hawaiians/Pacific-Islanders/Asian-Americans, persons with Rx OUD only, and persons without MDE or SUD particularly underutilized opioid-specific treatment. Among alcohol/drug use treatment users, self-help group and outpatient rehabilitation treatment were commonly used services. Conclusions Most people with OUD report no use of OUD treatment. Multifaceted interventions, including efforts to access insurance coverage, are required to change attitudes and knowledge towards addiction treatment in order to develop a supportive culture and infrastructure to enable treatment-seeking. Outreach efforts could target adolescents, minority groups, and the uninsured to improve access to treatment.
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                Author and article information

                Journal
                J Stud Alcohol Drugs Suppl
                J Stud Alcohol Drugs Suppl
                jsads
                Journal of Studies on Alcohol and Drugs. Supplement
                Rutgers University
                1946-584X
                1946-5858
                January 2019
                27 January 2019
                : Sup 18
                : 22-30
                Affiliations
                [ a ]Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
                Author notes
                [* ]Correspondence may be sent to Alison Ritter at the Drug Policy Modelling Program, Social Policy Research Centre, University of New South Wales, Kensington, NSW, Australia 2052, or via email at: Alison.ritter@ 123456unsw.edu.au .

                This article was prepared as part of the Australian Government Department of Health and Ageing commissioned review of alcohol and other drug treatment services but built on a number of pieces of commissioned research including from the New South Wales (NSW) Mental Health and Drug and Alcohol Office, the Youth Substance Abuse Service, Victoria, and work completed as part of The Drug and Alcohol Clinical Care & Prevention (DA-CCP) model, funded by the Commonwealth Department of Health and Ageing and the NSW Ministry of Health (Mental Health and Drug and Alcohol Office). Alison Ritter is funded by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship. Matthew Sunderland is funded by an NHMRC Postdoctoral Fellowship. Jenny Chalmers and Kari Lancaster are funded out of the Drug Policy Modelling Program core funds (Colonial Foundation Trust).

                Article
                22
                10.15288/jsads.2019.s18.22
                6377022
                30681945
                e0b2407e-8f8e-4bd6-b40a-25833bb562d7
                Copyright © 2019 by Alcohol Research Documentation, Inc.
                History
                : 18 April 2017
                : 07 February 2018
                Page count
                Figures: 0, Tables: 0, Pages: 9
                Categories
                Section I: General System Planning

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