Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence.

BACKGROUND: Alcohol use disorders are highly prevalent worldwide. However, only a minority with alcohol dependence seek and undergo treatment. From a public health perspective, it is important to understand why people do not seek treatment. OBJECTIVES: This study aims to describe how people with alcohol dependence perceive and discuss treatment for alcohol use disorders and their reasons for seeking and not seeking treatment. METHODS: 32 alcohol dependent adults from the general population participated in focus groups and individual interviews in Stockholm during 2011-2012. Data were analyzed with thematic content analysis. RESULTS: Suffering from alcohol dependence, as well as realizing the need for, and entering treatment, were associated with shame and stigma, and were strong barriers to treatment. Other barriers included the desire to deal with alcohol problems on one's own and the view that seeking treatment required total abstinence. Negative health-effects were mainly a nonissue. The participants' knowledge about treatment options was limited to lifelong abstinence, medication with Disulfiram and residential treatment. These were seen as unappealing and contrasted sharply with preferred treatment. CONCLUSIONS/IMPORTANCE: Public health literacy regarding alcohol use, dependence, and treatment ought to be improved in order to lower barriers to treatment. Treatment services need to better match the needs and wishes of potential service users, as well as taking stigmatization into account. In order to develop suitable treatments, and to reach the majority who do not seek treatment, the clinical understanding of alcohol dependence needs to be expanded to include mild to moderate dependence.