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‘Untreated help seekers’ in addictions deserve attention in future research

Dr Sadie Boniface and Prof Sir John Strang discuss the need for research to focus attention on those who present only for an initial appointment at drug and alcohol services

29 September 2019 –In a comment piece published in Lancet Psychiatry, Prof Sir John Strang and I discuss the need for research to focus attention on an overlooked group of people: those who present for an initial appointment at drug and alcohol services but do not return for subsequent appointments or begin treatment. We are calling this group ‘untreated help seekers’.

We have spent some time scoping out the best ways to conduct further research in this area as part of the NIHR BRC Maudsley’s Substance Use and Harms theme. To begin understanding why this matters, it’s important to know about the ‘treatment gap’. For both alcohol and other drugs, we know that most people who could potentially benefit are not in receipt of treatment: of almost 600,000 adults with alcohol dependence in England, only around one in eight receive treatment annually. The reasons behind this are complex, with one of the major reasons being that only a minority of people with substance use disorders perceive a need for treatment. Previous research has also shown 37% percent of initial appointments at alcohol services and 25% initial appointments at drug services are missed, the highest across all psychiatric specialities.

Setting aside the role of perceived need and motivation, among people who do want treatment, there are obstacles to getting the help that is needed. Drug and alcohol services have faced severe and repeated rounds of funding cuts in recent years. And although efforts have been made to make services more accessible by having walk-in clinics and self-referral pathways, challenges remain.

In our ongoing exploratory analyses of electronic health records in South London we have investigated people’s first recorded presentations at drug and alcohol services, focusing on clinics where we know clients walk-in, self-refer, or are referred from primary care and where we know second appointments would typically be offered within a maximum of a few weeks. We found that as many as one in three clients who make a first presentation do not return within four weeks.

We have been looking at whether this pattern is the same across alcohol and other drugs, and how having other mental health diagnoses may play a role in addictions help-seeking. We hope to have results to share soon. Electronic health records are a valuable resource, but they can only tell us a limited amount about untreated help seekers, and other longitudinal work is needed too.

Having also conducted patient and public involvement with almost 60 addictions clients, we think there is potential for research with clients coming to drug and alcohol services for the first time to be a success, with subsequent follow-up and linking people’s research data to their health records to be broadly acceptable. In our Comment we explain why this work is important, and how it fits in with the existing evidence base, and outline some of the next steps required to better understand and support this overlooked group.

Written by Sadie Boniface, resaerch coordinator for the Institute of Alcohol Studies

All IAS Blogposts are published with the permission of the author. The views expressed are solely the author's own and do not necessarily represent the views of the Institute of Alcohol Studies.